Provider Demographics
NPI:1649992462
Name:BLACK, ALLYSON (DPT)
Entity type:Individual
Prefix:DR
First Name:ALLYSON
Middle Name:
Last Name:BLACK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6860 WRIGLEY DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-0709
Mailing Address - Country:US
Mailing Address - Phone:757-876-9588
Mailing Address - Fax:
Practice Address - Street 1:1650 BONNIE LN STE 102
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-0517
Practice Address - Country:US
Practice Address - Phone:901-756-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000013057225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist