Provider Demographics
NPI:1992292296
Name:BALLEGEER, PAUL DAVID (DPT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:DAVID
Last Name:BALLEGEER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 STUART NELSON PARK RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-9678
Mailing Address - Country:US
Mailing Address - Phone:270-442-9502
Mailing Address - Fax:270-442-1927
Practice Address - Street 1:148 STUART NELSON PARK RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-9678
Practice Address - Country:US
Practice Address - Phone:270-442-9502
Practice Address - Fax:270-442-1927
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005841225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY005841Medicaid