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General NPI Number Information
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NPI Number | 1528569316
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Entity Type | Organization
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Legal Business Name | JORDAN C BLACK
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Dates
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Enumeration Date | 02/27/2018
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 325 W MORRIS BLVD STE B
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City | MORRISTOWN
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State | TN
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Zip | 37813-2237
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Country | US
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Telephone | 423-317-7772
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Fax | 423-317-7773
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Provider Business Mailing Address
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Address Line | 325 W MORRIS BLVD STE B
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City | MORRISTOWN
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State | TN
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Zip | 37813-2237
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Country | US
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Telephone | 423-375-8907
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Fax | 423-822-5514
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Authorized Official
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Title or Position | OWNER
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Name | JORDAN CHASE BLACK
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Credential | PT, DPT
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Telephone | 423-317-7772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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