Individual
ANTHONY TRAVON BALLAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3120 OLD FAITHFUL RD STE 200, CHEYENNE, WY 82001-5887
(307) 221-2937
Mailing address
2214 PEBRICAN AVE, CHEYENNE, WY 82001-3852
(307) 220-3201
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/15/2019
Last updated
05/15/2019
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