Provider Demographics
NPI:1447524442
Name:BALLARD, KELSEY (LPTA)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:BALLARD
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:BARDWELL
Mailing Address - State:KY
Mailing Address - Zip Code:42023-8564
Mailing Address - Country:US
Mailing Address - Phone:270-519-5805
Mailing Address - Fax:
Practice Address - Street 1:62 ADAMS ST
Practice Address - Street 2:
Practice Address - City:BARDWELL
Practice Address - State:KY
Practice Address - Zip Code:42023-8564
Practice Address - Country:US
Practice Address - Phone:270-519-5805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA02724225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant