Michelle Black
Individual provider Active NPI Physical Therapist · Owings Mills, MD
NPI 1508964396 · NPPES record last updated Nov 2, 2020
Key facts
- NPI
- 1508964396
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 19159 (MD)
- Practice address
- 10995 Owings Mills Blvd Ste 210
Owings Mills, MD 21117-1030 - Phone
- (410) 654-2300
- Fax
- (410) 654-4561
- NPI assigned
- Sep 20, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 1989
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Maryland Sportscare and Rehab LLC
Practice addresses (Care Compare)
10995 Owings Mills Blvd
Suite 210
Owings Mills, MD 21117-1030
Phone (410) 654-2300
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MD
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201119003195 | MD | Practitioner - Physical Therapist in Private Practice | 8527116631 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT2843 | DC | |
| Physical Therapist | 225100000X | |||
| Physical Therapist | 225100000X | 19159 | MD | Yes |
Addresses
Primary practice location
10995 Owings Mills Blvd Ste 210
Owings Mills, MD 21117-1030
Mailing address
5454 Wisconsin Ave
Suite 1555
Chevy Chase, MD 20815
Phone (301) 951-8593
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2843 | Other | DC | LICENSE # |
Other providers in Owings Mills, MD
- Lynnda R Bird
- Debra Lynn Birenbaum
- Tracy Chinita Bishop
- Andre Bisimwa
- BJ'S Wholesale Club Inc.
- Blackstar Solutions LLC
- Merlene J. Blair-Brown
- Jacqueline Kester Blair
- Leslie Y Bland
- David E Blanton
All providers in Owings Mills, MD · Physical Therapist in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 2, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.