Individual
RYAN BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
355 CROSSGATES BLVD, BRANDON, MS 39042-2602
(601) 825-3192
Mailing address
PO BOX 428, ORCHARD PARK, NY 14127-0428
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT5552
MS
Other
Enumeration date
10/28/2015
Last updated
10/28/2015
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