Sandra Juel Black, L.M.T.

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

227.005112 Issued in IL

Practice address

2052 N Cleveland Ave
Garden Suite
Chicago, IL 60614-4505

Phone

(773) 281-2225

Fax

(773) 281-2226

NPI assigned

Jun 1, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1433116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433116800000",
    "number": "1104206598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 371",
            "city": "SHELL ROCK",
            "state": "IA",
            "postal_code": "506700371",
            "telephone_number": "773-490-2259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2052 N CLEVELAND AVE",
            "address_2": "GARDEN SUITE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606144505",
            "telephone_number": "773-281-2225",
            "fax_number": "773-281-2226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "SANDRA",
        "middle_name": "JUEL",
        "credential": "L.M.T.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-06-01",
        "last_updated": "2015-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "IL",
            "license": "227.005112",
            "primary": true
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "IA",
            "license": "006290",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Patrice Black, OTR
• McKenna Black, PA-C
• Michael Richard Black, PSYD
• Paige Black, DMD
• Samantha Black, MA CCC-SLP/L
• Stephanie R Black, M.D.
• Terese Marie Black, D.C.
• Vonisha Lashawn Black, PMHNP-BC APRN MSN RN
• William Michael Black, DMD
• Amy Meredith Blackburn, M.D.

• Massage Therapist in Chicago, IL
• Providers in Chicago, IL by specialty
• Massage Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2015; 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.