Healthcare Provider Details

I. General information

NPI: 1780655092
Provider Name (Legal Business Name): TRACY PORTER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACY BRIGHTMAN PT

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1992 E STOP 13 RD
INDIANAPOLIS IN
46227-6267
US

IV. Provider business mailing address

33900 HARPER AVE STE 104
CLINTON TWP MI
48035-4258
US

V. Phone/Fax

Practice location:
  • Phone: 317-808-0230
  • Fax: 317-808-0231
Mailing address:
  • Phone: 586-350-2644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05015781A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: