Black, Misty Renae

Black, Misty Renae is an individual health care provider with primary practice located at 100 Pleasant Hill Ave N , Sebastopol CA 95472-3104. She recently has 2 registered licenses in different health care specialties including Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist. Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant is her primary health care specialty. Black, Misty Renae can be contacted via phone (707) 829-3282.

Contact Information

Primary practice address
100 Pleasant Hill Ave N Sebastopol CA 95472-3104
Phone: (707) 829-3282
Fax: (707) 829-3287
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant 225200000X AT6901 California
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X AT6901 California

Profile Details

NPI number 1043386220
LBN Legal business name Black, Misty Renae
Credentials Physical Therapist Assistant (PTA)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 28th, 2006
Last updated Mar 1st, 2022 - about 3 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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