Individual
CHADD DAVID BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPTA
Contact information
Practice address
1049 N EDGE TRL, VERONA, WI 53593-1942
(608) 845-2100
Mailing address
4711 EISENHOWER ST, OREGON, WI 53575-2817
(262) 210-7726
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
520-19
WI
Other
Enumeration date
10/13/2019
Last updated
10/13/2019
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