Provider Demographics
NPI:1992870869
Name:BLACK, NANCY LORRAINE (PT)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:LORRAINE
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 1:1212 N WASHINGTON ST
Mailing Address - Street 2:STE 104
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2401
Mailing Address - Country:US
Mailing Address - Phone:509-220-9422
Mailing Address - Fax:509-343-3343
Practice Address - Street 1:1212 N WASHINGTON ST
Practice Address - Street 2:ONE ROCKPOINTE SUITE 104
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201
Practice Address - Country:US
Practice Address - Phone:509-220-9422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-23
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00004008225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7122542Medicaid
WA7122542Medicaid