Jill Diane Black, PT, DPT, EDD

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

J10000513 Issued in DE

Practice address

701 Savannah Rd
A-1
Lewes, DE 19958-1550

Phone

(302) 644-2530

Fax

(302) 644-2556

NPI assigned

Aug 28, 2007

Last updated

Jul 3, 2014By the provider in NPPES

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 1

Other names 1

• Jill Black Lattanzi Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southern Delaware Physical Therapy, Inc.

  • Physical Therapist
  • Lewes, DE
  • NPI 1588690622
  NPD (past)
• Specialty Rehabilitation, Inc.

  • Occupational Therapist
  • Newark, DE
  • NPI 1952331308

  Physical Therapist

  NPD (past)

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

{
    "created_epoch": "1188259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404345600000",
    "number": "1184818601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 SAVANNAH RD",
            "address_2": "A-1",
            "city": "LEWES",
            "state": "DE",
            "postal_code": "199581550",
            "telephone_number": "302-644-2530",
            "fax_number": "302-644-2556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 SAVANNAH RD",
            "address_2": "A-1",
            "city": "LEWES",
            "state": "DE",
            "postal_code": "199581550",
            "telephone_number": "302-644-2530",
            "fax_number": "302-644-2556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "JILL",
        "middle_name": "DIANE",
        "name_prefix": "Dr.",
        "credential": "PT, DPT, EDD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-28",
        "last_updated": "2014-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "DE",
            "license": "J10000513",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1184818601",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JILL",
            "last_name": "LATTANZI",
            "middle_name": "BLACK",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Allison Birch, RN
• Rachel Birney, RN
• Lois Ann Bixby, RN
• Melissa Lyn Bixby
• Edward Black, RN
• Jenna Riddle Blades, R.N., B.S.N.
• Melissa Blades, RN
• Kimberly Blanch, RN
• Malina Michela Blankenship, FNP-C
• Kathryn Blanshine

• Physical Therapist in Lewes, DE
• Providers in Lewes, DE by specialty
• Physical Therapist in Delaware

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 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.