Individual
MICHAEL ROBERT BALLASCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AT
Contact information
Practice address
1202 W THOMAS RD, PHOENIX, AZ 85013-4208
(602) 285-7239
Mailing address
1202 W THOMAS RD, PHOENIX, AZ 85013-4208
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1644
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1369996076
VETERAN'S AFFAIRS
—
Enumeration date
11/24/2017
Last updated
11/24/2017
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