Individual
MR. ROBERT E BLACK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1001 E 17TH ST, BLOOMINGTON, IN 47408-1590
(812) 856-2225
(812) 855-1810
Mailing address
1207 W WINTERSWEET CT, BLOOMINGTON, IN 47404-1827
(812) 345-3343
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36000062A
IN
Other
Enumeration date
10/24/2005
Last updated
07/08/2007
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