Provider Demographics
NPI:1649660440
Name:BALLESTER, JONATHAN FERNANDEZ (PTA)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:FERNANDEZ
Last Name:BALLESTER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3807 W 187TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5601
Mailing Address - Country:US
Mailing Address - Phone:310-291-8943
Mailing Address - Fax:
Practice Address - Street 1:3807 W 187TH ST
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-5601
Practice Address - Country:US
Practice Address - Phone:310-291-8943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-31
Last Update Date:2015-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant