Provider Demographics
NPI:1346680287
Name:WILLIAMS, MARIA BALLESTAS (PT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:BALLESTAS
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5510 SW 41ST BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-4977
Mailing Address - Country:US
Mailing Address - Phone:855-297-8326
Mailing Address - Fax:888-503-7832
Practice Address - Street 1:4511 SW 48TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-9626
Practice Address - Country:US
Practice Address - Phone:866-236-1808
Practice Address - Fax:866-236-1808
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19910225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist