MEDICARE: JAYLON J PORTER PT

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	1182530	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5Y811	OTHER	AR	BCBS

General Provider Information

NPI Number	:	1194768622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYLON J PORTER PT

Provider Business Mailing Address
First Line	:	10125 T BURY LANE
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76708
Country	:	US
Telephone Number	:	479-857-4212
Fax Number	:	479-857-4212

Provider Business Practice Location Address
First Line	:	4416 TWIN CITY BLVD
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76502-5818
Country	:	US
Telephone Number	:	254-399-8255
Fax Number	:

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

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	01/26/2023

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Directions to “ JAYLON J PORTER PT” Practice Location

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