Provider Demographics
NPI:1215133764
Name:BLACK, JODY REBECCA (PT)
Entity type:Individual
Prefix:MRS
First Name:JODY
Middle Name:REBECCA
Last Name:BLACK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 SAINT FRANCIS LN
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-7364
Mailing Address - Country:US
Mailing Address - Phone:814-943-8250
Mailing Address - Fax:
Practice Address - Street 1:929 14TH ST
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-3028
Practice Address - Country:US
Practice Address - Phone:814-643-0337
Practice Address - Fax:814-643-9231
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013854L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist