Active NPI
Stephanie Black, ATC
- Specialist
- Coudersport, PA
National Provider Identifier
1609226281
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- RT005263
- Practice address
- 1001 E 2ND St
Coudersport, PA 16915-8161 - Phone
- (814) 274-9300
- NPI assigned
- Jun 15, 2016
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Specialist | 174400000X | RT005263 | PA | Primary |
Addresses
Primary practice location
1001 E 2ND St
Coudersport, PA 16915-8161
Mailing address
1001 E 2ND St
Coudersport, PA 16915-8161
Phone (814) 274-9300
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RT005263 | PA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1465948800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1465948800000",
"number": "1609226281",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1001 E 2ND ST",
"city": "COUDERSPORT",
"state": "PA",
"postal_code": "169158161",
"telephone_number": "814-274-9300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 E 2ND ST",
"city": "COUDERSPORT",
"state": "PA",
"postal_code": "169158161",
"telephone_number": "814-274-9300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "STEPHANIE",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-06-15",
"last_updated": "2016-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "PA",
"license": "RT005263",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coudersport, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.