Individual
MRS. LISA GAIL BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
525 13TH AVENUE, HUNTINGTON, WV 25701
(304) 781-2275
Mailing address
525 13TH AVENUE, HUNTINGTON, WV 25701
(304) 781-2275
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
0252
WV
Other
Enumeration date
09/28/2007
Last updated
09/28/2007
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