MEDICARE: LAUREL DELANEY BLACK PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5675	SC

General Provider Information

NPI Number	:	1588833362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREL DELANEY BLACK PT

Provider Business Mailing Address
First Line	:	216 SCUFFLETOWN RD STE B
Second Line	:
City	:	SIMPSONVILLE
State	:	SC
Zip	:	29681-7296
Country	:	US
Telephone Number	:	864-254-5899
Fax Number	:	864-254-5898

Provider Business Practice Location Address
First Line	:	216 SCUFFLETOWN RD STE B
Second Line	:
City	:	SIMPSONVILLE
State	:	SC
Zip	:	29681-7296
Country	:	US
Telephone Number	:	864-254-5899
Fax Number	:	864-254-5898

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2008
Last Update Date	:	01/22/2015

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Directions to “ LAUREL DELANEY BLACK PT” Practice Location

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