Individual
MISTY RENAE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
100 PLEASANT HILL AVE N, SEBASTOPOL, CA 95472-3104
(707) 829-3282
(707) 829-3287
Mailing address
100 PLEASANT HILL AVE N, SEBASTOPOL, CA 95472-3104
(707) 829-3282
(707) 829-3287
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
AT6901
CA
225200000X
Physical Therapy Assistant
Primary
AT6901
CA
Other
Enumeration date
11/28/2006
Last updated
03/01/2022
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