Provider Demographics
NPI:1750525234
Name:ISAAC, MARISA BALL (DPT)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:BALL
Last Name:ISAAC
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:MIGNE
Other - Last Name:BALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2085 A1A S STE 105
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32080-6505
Mailing Address - Country:US
Mailing Address - Phone:904-689-3336
Mailing Address - Fax:904-779-3213
Practice Address - Street 1:2085 A1A S STE 105
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32080-6505
Practice Address - Country:US
Practice Address - Phone:904-689-3336
Practice Address - Fax:904-779-3213
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT24653225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT24653OtherTHERAPY LICENSE