Doctor Name: | CHARLES GLENN BLACK |
NPI Number: | 1053424234 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PT |
License Number: | 18275 |
Business Practice Address: | 1231 Colonial Park Dr Severn, MD - 211444417 |
Business Phone Number: | 4105701446 |
Business Fax Number: | |
Mailing Address: | 1231 Colonial Park Dr, SEVERN |
State: | MD |
Postal Code: | 211444417 |
Phone Number: | 4105701446 |
Fax Number: | 4107217580 |
NPI Enumeration Date: | 08/15/2006 |
NPI Last Update Date: | 05/26/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 18275 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
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 |