Provider Demographics
NPI:1629229943
Name:BLACK, BELINDA MYERS (DPT)
Entity Type:Individual
Prefix:
First Name:BELINDA
Middle Name:MYERS
Last Name:BLACK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BELINDA
Other - Middle Name:L
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1194 E ROCK SPRINGS RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-2265
Mailing Address - Country:US
Mailing Address - Phone:202-210-1131
Mailing Address - Fax:
Practice Address - Street 1:555 13TH ST NW
Practice Address - Street 2:STE C112
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20004-1141
Practice Address - Country:US
Practice Address - Phone:202-210-1131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT8098225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1507790Medicaid