Individual
KYLE JOSEPH BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
350 S MAIN ST, FLORENCE, AZ 85132-8513
(520) 868-0098
(520) 868-1098
Mailing address
PO BOX 1400, FLORENCE, AZ 85132-3028
(520) 868-1098
(520) 868-1098
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
13245
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13245
ARIZONA STATE LICENSE
AZ
Enumeration date
08/22/2017
Last updated
03/17/2018
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