Individual
LYLE H BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
248 W 300 N, LOGAN, UT 84321-3810
(435) 754-0277
(435) 752-1318
Mailing address
248 W 300 N, LOGAN, UT 84321-3810
(435) 754-0277
(435) 752-1318
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
5271519-2401
UT
Other
Enumeration date
05/15/2008
Last updated
09/11/2008
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