Active NPI
Matthew John Black, MPT
- Physical Therapist
- Tulsa, OK
National Provider Identifier
1679769947
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 4036
- Practice address
- 4004 S Yale Ave
Tulsa, OK 74135-6017 - Phone
- (918) 622-4126
- Fax
- (918) 270-2398
- NPI assigned
- Sep 20, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 4036 | OK | Primary |
Addresses
Primary practice location
4004 S Yale Ave
Tulsa, OK 74135-6017
Mailing address
201 N 4TH St
Weatherford, OK 73096-4636
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200135840A | Medicaid | OK |
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 |
|---|---|---|---|
| 4036 | OK | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214784000000",
"number": "1679769947",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 N 4TH ST",
"city": "WEATHERFORD",
"state": "OK",
"postal_code": "730964636"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4004 S YALE AVE",
"city": "TULSA",
"state": "OK",
"postal_code": "741356017",
"telephone_number": "918-622-4126",
"fax_number": "918-270-2398"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "MATTHEW",
"middle_name": "JOHN",
"name_prefix": "Mr.",
"credential": "MPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-09-20",
"last_updated": "2008-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OK",
"license": "4036",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200135840A",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tulsa, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.