Individual
BRENDAN ALEXANDER BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
1321 SW MARKET ST, LEES SUMMIT, MO 64081-2904
(816) 607-7180
(816) 607-7181
Mailing address
1321 SW MARKET ST, LEES SUMMIT, MO 64081-2904
(816) 607-7180
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2021023467
MO
Other
Enumeration date
04/28/2021
Last updated
04/05/2024
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