Individual
DARRA BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
17111 SE BUSH ST, PORTLAND, OR 97236-1260
(503) 465-1031
Mailing address
17111 SE BUSH ST, PORTLAND, OR 97236-1260
(503) 465-1031
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
7725
OR
Other
Enumeration date
06/30/2008
Last updated
06/30/2008
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