Marshall R Black, CPO

NPI #1154357242 in Lewiston, Idaho

Provider Information

NPI Number: 1154357242
Entity Type: Individual
Name: Marshall R Black, CPO
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Orthotist
Credential: CPO
Enumeration Date: Jun 23, 2006
Last Updated: Nov 2, 2007

Practice Location

Address: 823 16TH AVE
City: Lewiston
State: Idaho
ZIP Code: 83501-3733
Phone: (208) 798-0200

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Orthotist	222Z00000X	Primary
Prosthetist	224P00000X

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