Provider Demographics
NPI:1548510381
Name:BALLARD, FAITH (CPED CO)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:
Last Name:BALLARD
Suffix:
Gender:F
Credentials:CPED CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3224 LAKE WOODARD DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-3659
Mailing Address - Country:US
Mailing Address - Phone:919-231-6890
Mailing Address - Fax:919-231-3490
Practice Address - Street 1:2704 WOOTEN BLVD SW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4428
Practice Address - Country:US
Practice Address - Phone:252-291-5858
Practice Address - Fax:252-291-5542
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist