Misty Renae Black, PTA

NPI #1043386220 in Sebastopol, California

Provider Information

NPI Number: 1043386220
Entity Type: Individual
Name: Misty Renae Black, PTA
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physical Therapy Assistant
Credential: PTA
Enumeration Date: Nov 28, 2006
Last Updated: Mar 1, 2022

Practice Location

Address: 100 PLEASANT HILL AVE N
City: Sebastopol
State: California
ZIP Code: 95472-3104
Phone: (707) 829-3282

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapy Assistant	225200000X	Primary
Physical Therapist	225100000X

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