| Doctor Name: | SANDRA JUEL BLACK |
| NPI Number: | 1104206598 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | L.M.T. |
| License Number: | 006290 |
| Business Practice Address: | 2052 N Cleveland Ave Garden Suite Chicago, IL - 606144505 |
| Business Phone Number: | 7732812225 |
| Business Fax Number: | 7732812226 |
| Mailing Address: | Po Box 371, SHELL ROCK |
| State: | IA |
| Postal Code: | 506700371 |
| Phone Number: | 7734902259 |
| Fax Number: | |
| NPI Enumeration Date: | 06/01/2015 |
| NPI Last Update Date: | 06/01/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225700000X |
| License Number: | 006290 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IA |
| 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. |