Individual
KELLY BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1114 W JACKSON ST, OZARK, MO 65721-9164
(417) 581-1234
Mailing address
1114 W JACKSON ST, OZARK, MO 65721-9164
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2001031153
MO
Other
Enumeration date
09/27/2016
Last updated
09/27/2016
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