Black, Evelyn J

Black, Evelyn J is an individual health care provider with primary practice located at 417 S Florida Ave , Lakeland FL 33801-5226. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant, which is considered as her primary health care specialty. Black, Evelyn J can be contacted via phone (863) 688-1800.

Contact Information

Primary practice address
417 S Florida Ave Lakeland FL 33801-5226
Phone: (863) 688-1800
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant 225200000X PTA18831 Florida

Profile Details

NPI number 1649368762
LBN Legal business name Black, Evelyn J
Credentials Physical Therapist Assistant (PTA)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 11th, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1649368762 NPPES
Florida Other PTA18831 PHYSICAL THERAPIST ASST

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