Provider Demographics
NPI:1679636815
Name:BLACK, EMILY BRIGANCE (PT)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:BRIGANCE
Last Name:BLACK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 WORD LN
Mailing Address - Street 2:
Mailing Address - City:HARVEST
Mailing Address - State:AL
Mailing Address - Zip Code:35749-5810
Mailing Address - Country:US
Mailing Address - Phone:256-603-0803
Mailing Address - Fax:
Practice Address - Street 1:600 WHITESPORT CIR SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6495
Practice Address - Country:US
Practice Address - Phone:256-512-0941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3102225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALQ31556Medicare UPIN
AL51557058Medicare ID - Type Unspecified