| Doctor Name: | MISTY RENAE BLACK |
| NPI Number: | 1043386220 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PTA |
| License Number: | AT6901 |
| Business Practice Address: | 795 Farmers Ln Ste 10 Santa Rosa, CA - 954056718 |
| Business Phone Number: | 7075717615 |
| Business Fax Number: | 7075718601 |
| Mailing Address: | 795 Farmers Ln, Ste 10 SANTA ROSA |
| State: | CA |
| Postal Code: | 954056718 |
| Phone Number: | 7075717615 |
| Fax Number: | 7075718601 |
| NPI Enumeration Date: | 11/28/2006 |
| NPI Last Update Date: | 03/11/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | AT6901 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |