Active NPI
Keith Black, DPT
- Physical Therapist
- Greenville, SC
National Provider Identifier
1942861851
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PTT4746
- Practice address
- 536 Old Howell Rd
Greenville, SC 29615-1969 - Phone
- (864) 244-3626
- NPI assigned
- Jun 23, 2019
- 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 | PTT4746 | FL | Primary |
Addresses
Primary practice location
536 Old Howell Rd
Greenville, SC 29615-1969
Mailing address
1631 E Amelia St
Orlando, FL 32803-5504
Phone (954) 261-7347
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 |
|---|---|---|---|
| PTT4746 | FL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1561248000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1561248000000",
"number": "1942861851",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1631 E AMELIA ST",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328035504",
"telephone_number": "954-261-7347"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "536 OLD HOWELL RD",
"city": "GREENVILLE",
"state": "SC",
"postal_code": "296151969",
"telephone_number": "864-244-3626"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "KEITH",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-06-23",
"last_updated": "2019-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PTT4746",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greenville, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.