Doctor Name: | ANDREW ALLEN BLACK |
NPI Number: | 1063838720 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LMT |
License Number: | 19070 |
Business Practice Address: | 9735 Sw Shady Ln Suite 100 Tigard, OR - 972235481 |
Business Phone Number: | 5036392800 |
Business Fax Number: | 5036394044 |
Mailing Address: | 9735 Sw Shady Ln, Suite 100 TIGARD |
State: | OR |
Postal Code: | 972235481 |
Phone Number: | 5036392800 |
Fax Number: | 5036394044 |
NPI Enumeration Date: | 03/05/2014 |
NPI Last Update Date: | 03/05/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 19070 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |