Individual
KENNETH BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
86TH 22ND AVE, MEMORIAL HOME, MOUNDRIDGE, KS 67107-7003
(620) 345-2901
(620) 345-2937
Mailing address
900 SPRUCE ST, HALSTEAD, KS 67056-2524
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
14-01477
KS
Other
Enumeration date
06/26/2007
Last updated
07/08/2007
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