Individual
DR. JILL DIANE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT, EDD
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
J10000513
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1184818601
—
DE
Enumeration date
08/28/2007
Last updated
07/03/2014
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