BLACK DAVID CHADD - NPI: 1326680109


Mood disorder is a group of diagnoses in the Diagnostic and Statistical Manual of Mental Disorders classification system where a disturbance in the person's mood is hypothesized to be the main underlying feature. The classification is known as mood (affective) disorders in International Classification of Diseases (ICD).

NPI: 1326680109
Entity Type: Person: individual human being who furnishes health care.
Provider First Name: CHADD
Provider Last Name: BLACK
Provider Middle Name: DAVID
Provider Gender Code: M
Provider Credential Text: LPTA
Provider Enumeration Date: 10/13/2019
Last Update Date: 10/13/2019

Business Address:

Provider First Line Business Mailing Address: 4711 EISENHOWER ST
Provider Business Mailing Address City Name: OREGON
Provider Business Mailing Address State Name: WI
Provider Business Mailing Address Postal Code: 53575
Provider Business Mailing Address Country Code (If outside U.S.): US
Phone: 2622107726

Mailing Address:

Provider First Line Business Practice Location Address: 1049 N EDGE TRL
Provider Business Practice Location Address City Name: VERONA
Provider Business Practice Location Address State Name: WI
Provider Business Practice Location Address Postal Code: 53593
Provider Business Practice Location Address Country Code (If outside U.S.): US
Phone: 6088452100

Primary Taxonomy:

Taxonomy Code: 225200000X
License Number: 520-19
License State: WI
Healthcare Provider Primary Taxonomy Switch: Y - The taxonomy is the primary taxonomy (there can be only one per NPI record
Type: Respiratory
Classification: Developmental
Specialization: Rehabilitative and Restorative Service Providers
Definition: Physical Therapy Assistant
Source: The National Provider Identifier

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