Stacy Renee Black, MS,PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

3429 Issued in NM

Practice address

9108 Los Arboles Ave NE
Albuquerque, NM 87112-1267

Phone

(505) 508-8589

Fax

(505) 294-4552

NPI assigned

Sep 24, 2007

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Peak Motion Physical Therapy, Inc.

  • Physical Therapy Clinic/Center
  • Albuquerque, NM
  • NPI 1669639043

  Physical Therapist

  NPD (past)

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

{
    "created_epoch": "1190592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441065600000",
    "number": "1982890844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9108 LOS ARBOLES AVE NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871121267",
            "telephone_number": "505-508-8589",
            "fax_number": "505-294-4552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9108 LOS ARBOLES AVE NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871121267",
            "telephone_number": "505-508-8589",
            "fax_number": "505-294-4552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "STACY",
        "middle_name": "RENEE",
        "name_prefix": "Ms.",
        "credential": "MS,PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-24",
        "last_updated": "2015-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NM",
            "license": "3429",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Michelle Black, PA-S
• M. Sue Pullin Black, RPH
• Pamela O Black, MD
• Patricia Black, MD
• Randolph E Black, M.D.
• Stephen R. Black, D.D.S.
• Vicki Heinz Black, LMFT
• Donald Blackburn
• Mackenzie Blackburn
• Shawne Ann Blackburn, LPCC

• Physical Therapist in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Physical Therapist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2015; 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.