Tracey Black Powell, PHYSICAL THERAPIST

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1762 Issued in NC

Practice address

1130 N Church St
Suite 201
Greensboro, NC 27401-1038

Phone

(336) 275-2285

NPI assigned

Oct 21, 2009

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Tracey Elaine Black Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1256083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414627200000",
    "number": "1023344397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 N CHURCH ST STE 201",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274011041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 N CHURCH ST",
            "address_2": "SUITE 201",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274011038",
            "telephone_number": "336-275-2285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POWELL",
        "first_name": "TRACEY",
        "middle_name": "BLACK",
        "credential": "PHYSICAL THERAPIST",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-10-21",
        "last_updated": "2014-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "1762",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1543A",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7212716",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACEY",
            "last_name": "BLACK",
            "middle_name": "ELAINE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Laura Schuster Powell, RN
• Shafik Powell, LCSWA
• Shatara Powell, RN
• Shyla Louise Powell, LMHC
• Tequan Powell
• Turiya Powell
• Lynsey Power, LCMHCA
• Powers of Comfort LLC
• Arcola Powers, HOME CARE PROVIDER
• James Nichols Powers, M.D.

• Physical Therapist in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Physical Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.