| Marisa Mccormack, | |
|
4 9th Ave Bldg C, Shalimar, FL 32579-1746 | |
| (850) 613-4099 | |
| Not Available |
| Full Name | Marisa Mccormack |
|---|---|
| Gender | Female |
| Speciality | Physical Therapist |
| Location | 4 9th Ave Bldg C, Shalimar, Florida |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730705518 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | PT302271 (California) | Secondary |
| 225100000X | Physical Therapist | PT35820 (Florida) | Primary |
| Provider Name | Pro Vita Physical Therapy Llc |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1790332351 PECOS PAC ID: 6901226976 Enrollment ID: O20201013000689 |
| Mailing Address | Practice Location Address |
|---|---|
| Marisa Mccormack, 574 N Knight Dr, Edwards, CA 93523-2735 Ph: () - | Marisa Mccormack, 4 9th Ave Bldg C, Shalimar, FL 32579-1746 Ph: (850) 613-4099 |
Krista L Evans, DPT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 104 Hands Cove Ln, Shalimar, FL 32579 Phone: 210-471-8375 | |
Amy R Davis, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1200 Hawthorn House Dr, Shalimar, FL 32579 Phone: 850-609-2550 | |
Michael Travers, Physical Therapist Medicare: Medicare Enrolled Practice Location: 4 9th Ave Ste G, Shalimar, FL 32579 Phone: 205-919-9349 | |
Pro Vita Physical Therapy Llc Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 4 9th Ave Bldg C, Shalimar, FL 32579 Phone: 850-331-3017 Fax: 855-978-1838 |