Provider Demographics
NPI:1144343385
Name:BALL, MICHAEL P (RPT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:P
Last Name:BALL
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:237 S BEAUMONT AVE
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-4624
Mailing Address - Country:US
Mailing Address - Phone:479-495-6326
Mailing Address - Fax:479-495-3336
Practice Address - Street 1:719 N DETROIT
Practice Address - Street 2:HIGHWAY 10 AT DETROIT
Practice Address - City:DANVILLE
Practice Address - State:AR
Practice Address - Zip Code:72833
Practice Address - Country:US
Practice Address - Phone:479-495-6326
Practice Address - Fax:479-495-3336
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT1574225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPT1574OtherSTATE LICENSE NUMBER