Healthcare Provider Details

I. General information

NPI: 1922020809
Provider Name (Legal Business Name): KAREN BALL LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4811 SERENA CIR
ST AUGUSTINE FL
32084-7014
US

IV. Provider business mailing address

4811 SERENA CIR
ST AUGUSTINE FL
32084-7014
US

V. Phone/Fax

Practice location:
  • Phone: 904-553-4067
  • Fax: 904-829-0257
Mailing address:
  • Phone: 904-553-4067
  • Fax: 904-829-0257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA9943
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: