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Individual

JUSTIN KYLE BALLIET

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
2000 SPROUL RD STE 100, BROOMALL, PA 19008-3509
(484) 337-5314
Mailing address
3803 W CHESTER PIKE STE 160, NEWTOWN SQUARE, PA 19073-2336
(484) 337-1632

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
OA004604
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0015234460006
PA
01
668795
MEDICARE UPIN
PA
Enumeration date
08/16/2018
Last updated
05/31/2025
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