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SHANNON BLACK

>> Physical Therapist >> Respiratory, Developmental, Rehabilitative and Restorative Service Providers

Registrant NPI Number: 1629184213

Individual Registrant:
 SHANNON  BLACK 
Gender: F
Not Sole Proprietor

Location and contact information for practice:
4100 LAKE OTIS PKWY STE 106 ANCHORAGE, AK 99508-5222 US
Tel: 907-550-6180  Fax: --

Contact information for business:
331 PETTIS RD  ANCHORAGE, AK 99515-3350 US
Tel: 907-522-2435  Fax: --

Registration Information:
NPI: 1629184213
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y225100000XRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Physical Therapist

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
LICENSE #1036AK01




HEALTH CARE JOBS AK - Page 1



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