Taylor Black, DPT, C.S.C.S.
Individual provider Active NPI Physical Therapist · Portland, ME
NPI 1992474753 · NPPES record last updated Sep 7, 2021
Key facts
- NPI
- 1992474753
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT6035 (ME)
- Practice address
- 1145 Brighton Ave
Portland, ME 04102-1025 - Phone
- (207) 541-6500
- NPI assigned
- Sep 7, 2021
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT6035 | ME | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT6035 | ME | Yes |
Addresses
Primary practice location
1145 Brighton Ave
Portland, ME 04102-1025
Mailing address
49 Technology Dr Unit 51
Bedford, NH 03110-6970
Phone (760) 695-2899
Other providers in Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 7, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.