Provider Demographics
NPI:1669603809
Name:BLACK DARBY, HEATHER LYNN (MSPT)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:LYNN
Last Name:BLACK DARBY
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:LYNN
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSPT
Mailing Address - Street 1:1650 LYNDON FARM CT STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5005
Mailing Address - Country:US
Mailing Address - Phone:304-917-3660
Mailing Address - Fax:304-917-3674
Practice Address - Street 1:841 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:WELLSBURG
Practice Address - State:WV
Practice Address - Zip Code:26070-1528
Practice Address - Country:US
Practice Address - Phone:304-737-0437
Practice Address - Fax:304-737-0581
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205991225100000X
NV2976225100000X
WVPT004683225100000X
CA29537225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist