Provider Demographics
NPI:1760922934
Name:BLACK, DANIEL RYAN
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:RYAN
Last Name:BLACK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5235 WESTBARD AVE APT 307
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20816-1411
Mailing Address - Country:US
Mailing Address - Phone:845-220-6193
Mailing Address - Fax:
Practice Address - Street 1:1120 20TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-3406
Practice Address - Country:US
Practice Address - Phone:845-220-6193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist