Individual
MR. RANDY ALLAN BALLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
3112 VALERIE DR, CHAMPAIGN, IL 61822-1831
(217) 766-8137
Mailing address
3112 VALERIE DR, CHAMPAIGN, IL 61822-1831
(217) 766-8137
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096.001564
IL
Other
Enumeration date
12/30/2014
Last updated
12/30/2014
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