Individual
KEITH BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
536 OLD HOWELL RD, GREENVILLE, SC 29615-1969
(864) 244-3626
Mailing address
1631 E AMELIA ST, ORLANDO, FL 32803-5504
(954) 261-7347
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PTT4746
FL
Other
Enumeration date
06/23/2019
Last updated
06/23/2019
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