Individual
ALFRED ALEXIS BALLEZA MIRANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3007 PANOLA RD STE C, LITHONIA, GA 30038-2492
(770) 987-1122
Mailing address
1200 CORPORATE DR STE 400, HOOVER, AL 35242-5424
(866) 518-0283
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
012126
CT
225100000X
Physical Therapist
Primary
PT017569
GA
225100000X
Physical Therapist
—
—
Other
Enumeration date
05/30/2024
Last updated
03/20/2025
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