Individual
MRS. JULIE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2061 HIGHWAY 52 SOUTH, MONCKS CORNER, SC 29461
(843) 761-4622
(843) 761-4625
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3600
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP1753
—
SC
05
—
TH1760
—
SC
Enumeration date
08/04/2006
Last updated
06/21/2024
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