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General NPI Number Information
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NPI Number | 1477368876
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Entity Type | Organization
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Legal Business Name | BLACK ENTERPRISES, INC
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Dates
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Enumeration Date | 02/12/2025
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 2610 SE CLINTON ST STE E
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City | PORTLAND
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State | OR
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Zip | 97202-1273
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Country | US
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Telephone | 808-280-6470
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Fax |
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Provider Business Mailing Address
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Address Line | 4725 SE SALMON ST UNIT A
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City | PORTLAND
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State | OR
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Zip | 97215-2577
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Country | US
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Telephone | 808-280-6470
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | PETER D BLACK
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Credential | LMT
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Telephone | 808-280-6470
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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 |
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License Number State |
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