Provider Demographics
NPI:1942559463
Name:BLACK, THOMAS ROBERT JR (ACSM RCEP)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ROBERT
Last Name:BLACK
Suffix:JR
Gender:M
Credentials:ACSM RCEP
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:168 DENSLOW RD
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-3188
Mailing Address - Country:US
Mailing Address - Phone:413-526-9945
Mailing Address - Fax:
Practice Address - Street 1:168 DENSLOW RD
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-3188
Practice Address - Country:US
Practice Address - Phone:413-526-9945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist