Evelyn J Black, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA18831 Issued in FL

Practice address

417 S Florida Ave
Lakeland, FL 33801-5226

Phone

(863) 688-1800

NPI assigned

Oct 11, 2006

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Leading Edge Physical Therapy & Sports, Inc.

  • Physical Therapist
  • Lakeland, FL
  • NPI 1003903261
  NPD (past)

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1649368762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2375 RIVERWOOD DR",
            "city": "MULBERRY",
            "state": "FL",
            "postal_code": "338608322",
            "telephone_number": "863-370-2562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 S FLORIDA AVE",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338015226",
            "telephone_number": "863-688-1800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "EVELYN",
        "middle_name": "J",
        "name_prefix": "Mrs.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA18831",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICAL THERAPIST ASST",
            "identifier": "PTA18831",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bizzi Bodiz, LLC (Bizzi Bodiz)
• Elise Christine Bjelica, ARNP
• BKK Service of Central Florida, Inc (Comfort Keepers)
• Black Swan Counseling Services, LLC
• Amy Black, MASSAGE THERAPIST
• Robert Alexander Blackburn, D.C.
• Bruce Blain
• Marion Blain
• Blake and Franklin MD PA
• Stacie Blalock

• Physical Therapy Assistant in Lakeland, FL
• Providers in Lakeland, FL by specialty
• Physical Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.