Black, Robert Grant

Black, Robert Grant is an individual health care provider with primary practice located at 285 Vista Drive Suite A, Pocatello ID 83201. He recently has 2 registered licenses in different health care specialties including Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, Other Service Providers / Specialist. Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist is his primary health care specialty. Black, Robert Grant can be contacted via phone (208) 478-1488.

Contact Information

Primary practice address
285 Vista Drive Suite A Pocatello ID 83201
Phone: (208) 478-1488
Fax: (208) 478-1498
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 3435682401 Utah
Other Service Providers / Specialist 174400000X PT-1705 Idaho

Profile Details

NPI number 1457499428
LBN Legal business name Black, Robert Grant
Credentials Physical Therapist (PT)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 2nd, 2007
Last updated Aug 20th, 2008 - about 17 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 1457499428 NPPES
Utah MEDICAID D4888

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