Provider Demographics
NPI:1255673422
Name:BLACK, BYRON KEITH (PHD, RCEP)
Entity Type:Individual
Prefix:DR
First Name:BYRON
Middle Name:KEITH
Last Name:BLACK
Suffix:
Gender:M
Credentials:PHD, RCEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1337 BANDERA HWY
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-9555
Mailing Address - Country:US
Mailing Address - Phone:210-569-4129
Mailing Address - Fax:
Practice Address - Street 1:1337 BANDERA HWY
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-9555
Practice Address - Country:US
Practice Address - Phone:830-315-7325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist