Individual
SHANNON BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4100 LAKE OTIS PKWY, STE 106, ANCHORAGE, AK 99508-5222
(907) 550-6180
Mailing address
331 PETTIS RD, ANCHORAGE, AK 99515-3350
(907) 522-2435
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1036
LICENSE #
AK
Enumeration date
08/23/2006
Last updated
07/08/2007
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