Provider Demographics
NPI:1518163955
Name:BALLARD, JENNIFER SNELL (DPT, ATC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SNELL
Last Name:BALLARD
Suffix:
Gender:F
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8961 BIG HORN TRL
Mailing Address - Street 2:
Mailing Address - City:PIKE ROAD
Mailing Address - State:AL
Mailing Address - Zip Code:36064-2387
Mailing Address - Country:US
Mailing Address - Phone:334-233-3725
Mailing Address - Fax:
Practice Address - Street 1:1500 E FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2148
Practice Address - Country:US
Practice Address - Phone:334-833-4497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH 50782251X0800X
AL6612255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic