Healthcare Provider Details

I. General information

NPI: 1427361468
Provider Name (Legal Business Name): CHRISTINE BLACK PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2010
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 POCKET RD
HURT VA
24563-2023
US

IV. Provider business mailing address

1948 THOMSON DR
LYNCHBURG VA
24501-1009
US

V. Phone/Fax

Practice location:
  • Phone: 434-324-9750
  • Fax: 434-324-9796
Mailing address:
  • Phone: 434-845-9053
  • Fax: 434-528-2788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305206549
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: