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General NPI Number Information
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NPI Number | 1750525234
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Entity Type | Individual
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Provider Name | MARISA BALL ISAAC D.P.T.
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Gender | Female
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Dates
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Enumeration Date | 04/28/2009
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 2085 A1A S STE 105
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City | SAINT AUGUSTINE BEACH
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State | FL
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Zip | 32080-6505
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Country | US
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Telephone | 904-689-3336
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Fax | 904-779-3213
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Provider Business Mailing Address
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Address Line | 2085 A1A S STE 105
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City | SAINT AUGUSTINE BEACH
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State | FL
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Zip | 32080-6505
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Country | US
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Telephone | 904-689-3336
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Fax | 904-779-3213
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT24653
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License Number State | FL
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