Individual
MR. NICHOLAS ANDREW BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
167 TUCKER BROOK RD, LINCOLNVILLE, ME 04849-5528
(207) 763-2745
Mailing address
167 TUCKER BROOK RD, LINCOLNVILLE, ME 04849-5528
(207) 763-2745
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PA4548
ME
Other
Enumeration date
12/16/2015
Last updated
12/16/2015
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