NPI 1154357242

Marshall R Black, CPO

Practitioner Orthotist Lewiston, ID

Practice location

Address: 823 16th Ave, Lewiston, ID 83501-3733
Phone: (208) 798-0200
Fax: (208) 798-0201

Registered specialties (2)

Orthotist Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 222Z00000X

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Prosthetist

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 224P00000X

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Registry record

NPI: 1154357242
Entity type: Individual
Sex (as registered): Male
NPI issued: 23 Jun 2006
Record last updated: 2 Nov 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.