Provider Demographics
NPI:1972831725
Name:LISTON, MARIA ARZEL BALAN
Entity Type:Individual
Prefix:MISS
First Name:MARIA ARZEL
Middle Name:BALAN
Last Name:LISTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5241 JOG LN
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6652
Mailing Address - Country:US
Mailing Address - Phone:832-375-4237
Mailing Address - Fax:
Practice Address - Street 1:3201 W COMMERCIAL BLVD BLDG BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-3440
Practice Address - Country:US
Practice Address - Phone:954-332-4445
Practice Address - Fax:954-739-4247
Is Sole Proprietor?:No
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist