Individual provider · NPI-1

Marissa Balledos, LPT

Physical Therapist · Conroe, TX

NPI number1821035007
StatusActive
Last updated in NPPESJul 8, 2007

Details

NPI
1821035007
Entity type
Individual (NPI-1)
Name
Marissa Balledos
Credential
LPT
Sex
Female
Sole proprietor
No
Enumeration date
May 31, 2006
Last updated
Jul 8, 2007

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
225100000X Physical Therapist1081750TXYes

Practice location

508 Medical Center Blvd
Conroe, TX 77304-2808

Phone 936-521-8295 · Fax 936-521-8281

Mailing address

508 Medical Center Blvd
Conroe, TX 77304-2808

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