MEDICARE: AYSIA STARR PORTER DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist		CT

General Provider Information

NPI Number	:	1003749532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYSIA STARR PORTER DPT

Provider Business Mailing Address
First Line	:	777 ECHO LAKE RD UNIT I
Second Line	:
City	:	WATERTOWN
State	:	CT
Zip	:	06795-6618
Country	:	US
Telephone Number	:	203-850-1176
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 MAIN ST N
Second Line	:
City	:	SOUTHBURY
State	:	CT
Zip	:	06488-3840
Country	:	US
Telephone Number	:	959-209-4318
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2026
Last Update Date	:	06/04/2026

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Directions to “ AYSIA STARR PORTER DPT” Practice Location

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