Healthcare Provider Details

I. General information

NPI: 1952310708
Provider Name (Legal Business Name): MELINDA KAY BLACK PT,DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12819 HWY 231 431 N SUITE G
HAZEL GREEN AL
35750-8629
US

IV. Provider business mailing address

12819 HWY 231 431 N SUITE G
HAZEL GREEN AL
35750-8629
US

V. Phone/Fax

Practice location:
  • Phone: 256-829-9544
  • Fax: 256-829-9522
Mailing address:
  • Phone: 256-829-9544
  • Fax: 256-829-9522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT0000008834
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH2496
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: