Active NPI
Marissa Balledos, LPT
- Physical Therapist
- Conroe, TX
National Provider Identifier
1821035007
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1081750
- Practice address
- 508 Medical Center Blvd
Conroe, TX 77304-2808 - Phone
- (936) 521-8295
- Fax
- (936) 521-8281
- NPI assigned
- May 31, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1081750 | TX | Primary |
Addresses
Primary practice location
508 Medical Center Blvd
Conroe, TX 77304-2808
Mailing address
508 Medical Center Blvd
Conroe, TX 77304-2808
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1081750 | TX | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sadler Clinic Association | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Multi-Specialty Clinic/Center
- Conroe, TX
- NPI 1114979127
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149033600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1821035007",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "508 MEDICAL CENTER BLVD",
"city": "CONROE",
"state": "TX",
"postal_code": "773042808"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "508 MEDICAL CENTER BLVD",
"city": "CONROE",
"state": "TX",
"postal_code": "773042808",
"telephone_number": "936-521-8295",
"fax_number": "936-521-8281"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALLEDOS",
"first_name": "MARISSA",
"credential": "LPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1081750",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Conroe, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.