Kenneth Black

NPI #1073719050 in Moundridge, Kansas

Provider Information

NPI Number: 1073719050
Entity Type: Individual
Name: Kenneth Black
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physical Therapy Assistant
Enumeration Date: Jun 26, 2007
Last Updated: Jul 8, 2007

Practice Location

Address: 86TH 22ND AVE
Address 2: MEMORIAL HOME
City: Moundridge
State: Kansas
ZIP Code: 67107-7003
Phone: (620) 345-2901

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapy Assistant	225200000X	Primary

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