Provider Demographics
NPI:1083641047
Name:BALL, MARTIN (RPT)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:
Last Name:BALL
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 E TREASURE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BAY VILLAGE
Mailing Address - State:FL
Mailing Address - Zip Code:33141-4300
Mailing Address - Country:US
Mailing Address - Phone:786-331-7444
Mailing Address - Fax:305-675-2755
Practice Address - Street 1:7601 E TREASURE DR
Practice Address - Street 2:503
Practice Address - City:NORTH BAY VILLAGE
Practice Address - State:FL
Practice Address - Zip Code:33141-4300
Practice Address - Country:US
Practice Address - Phone:786-331-7444
Practice Address - Fax:305-675-2755
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT10683225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist