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SHANNON BLACK
>> Physical Therapist >> Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersRegistrant NPI Number: 1629184213
Individual Registrant: SHANNON BLACK
Gender: F
Not Sole Proprietor
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: --
Tel: 907-550-6180 Fax: --
Contact information for business:
331 PETTIS RD ANCHORAGE, AK 99515-3350 US
Tel: 907-522-2435 Fax: --
Tel: 907-522-2435 Fax: --
Registration Information:
NPI: 1629184213
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers Physical Therapist |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| LICENSE # | 1036 | AK | 01 |
