ROBERT GRANT BLACK

POCATELLO, ID
NPI1457499428
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy225100000X Physical Therapist
(Licence: UT  3435682401)
Additional Taxonomies174400000X Specialist
(Licence: ID  PT-1705)
Enumeration Date2007-02-02
Last Update Date2008-08-20
Business Address
-- ROBERT GRANT BLACK PT
285 VISTA DRIVE SUITE A
POCATELLO, ID 83201
Phone number: 208-478-1488
Mailing Address
-- ROBERT GRANT BLACK PT
2176 E. FRANKLIN ROAD SUITE 100
MERIDIAN, ID 83642-9024
Phone number: 208-288-1155