Individual
ELLIOTT BALLENTINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
15 IVIE RD, CAPE ELIZABETH, ME 04107-1706
(216) 501-0171
Mailing address
4560 SE INTERNATIONAL WAY, STE 100, MILWAUKIE, OR 97222-4628
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
61741
OR
Other
Enumeration date
06/16/2016
Last updated
07/09/2019
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