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General NPI Number Information
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NPI Number | 1336043470
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Entity Type | Individual
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Provider Name | XAVIER BLACK LMT
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Gender | Male
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Dates
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Enumeration Date | 10/05/2026
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Last Update Date | 10/05/2026
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Provider Practice Location Address
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Address Line | 112 SUNCHASER DR
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City | COLUMBIA
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State | SC
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Zip | 29229-7307
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Country | US
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Telephone | 803-807-3003
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Fax |
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Provider Business Mailing Address
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Address Line | 112 SUNCHASER DR
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City | COLUMBIA
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State | SC
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Zip | 29229-7307
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 14521
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License Number State | SC
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