Provider Demographics
NPI:1720760721
Name:BALL, EMILY KAY (PTA)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:KAY
Last Name:BALL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:EMILY
Other - Middle Name:KAY
Other - Last Name:SEMJONOVS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:5627 W FLOWING LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-5514
Mailing Address - Country:US
Mailing Address - Phone:425-770-9664
Mailing Address - Fax:
Practice Address - Street 1:9514 4TH ST NE UNIT 101
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-1937
Practice Address - Country:US
Practice Address - Phone:425-397-2327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-01
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160794711225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant