Individual
BLAKE A. BALLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
314 MAIN ST STE C, MONTICELLO, MS 39654-3702
(601) 587-2563
(601) 587-0472
Mailing address
PO BOX 457, MONTICELLO, MS 39654-0457
(601) 587-2563
(601) 587-0472
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA6757
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTA6757
MS STATE BOARD OF PHYSICAL THERAPY
MS
Enumeration date
11/05/2020
Last updated
11/05/2020
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