Active NPI
Andrew Black III, DPT, OCS
- Orthopedic Physical Therapist
- Virginia Beach, VA
National Provider Identifier
1245620137
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopedic Physical Therapist
- License
- 2305204346
- Practice address
- 1725 Laskin Rd
Virginia Beach, VA 23454 - Phone
- (757) 652-4417
- NPI assigned
- Jan 29, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopedic Physical Therapist | 2251X0800X | 2305204346 | VA | Primary |
Addresses
Primary practice location
1725 Laskin Rd
Virginia Beach, VA 23454
Mailing address
3500 Royal Palm CT
Virginia Beach, VA 23452
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2305204346 | VA | MD | Orthopedic Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1422489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1422489600000",
"number": "1245620137",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3500 ROYAL PALM CT",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "23452"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1725 LASKIN RD",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "23454",
"telephone_number": "757-652-4417"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "ANDREW",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "DPT, OCS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-01-29",
"last_updated": "2015-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "2251X0800X",
"taxonomy_group": "",
"desc": "Physical Therapist, Orthopedic",
"state": "VA",
"license": "2305204346",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Virginia Beach, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 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.