Provider Demographics
NPI:1053600593
Name:BARROGA, NOEMI BALLESTEROS (PT)
Entity type:Individual
Prefix:
First Name:NOEMI
Middle Name:BALLESTEROS
Last Name:BARROGA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 BROWNS CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-9296
Mailing Address - Country:US
Mailing Address - Phone:901-634-0421
Mailing Address - Fax:
Practice Address - Street 1:781 BROWNS CHURCH RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-9296
Practice Address - Country:US
Practice Address - Phone:731-427-0058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000002179225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist