Individual
MICHAEL RAY BALLANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
825 W LOCKEFORD ST, LODI, CA 95240-1633
(209) 331-7471
(209) 331-7464
Mailing address
12270 KIRKWOOD ST, HERALD, CA 95638-9765
(209) 663-8013
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT18492
CA
Other
Enumeration date
05/17/2021
Last updated
05/17/2021
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