Individual
MRS. EVELYN J BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
417 S FLORIDA AVE, LAKELAND, FL 33801-5226
(863) 688-1800
Mailing address
2375 RIVERWOOD DR, MULBERRY, FL 33860-8322
(863) 370-2562
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA18831
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTA18831
PHYSICAL THERAPIST ASST
FL
Enumeration date
10/11/2006
Last updated
07/08/2007
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