Healthcare Provider Details

I. General information

NPI: 1932972171
Provider Name (Legal Business Name): PATRICK BERRY PORTER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2023
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 N FAYETTEVILLE ST
ASHEBORO NC
27203-4728
US

IV. Provider business mailing address

218 FOUST ST STE C
ASHEBORO NC
27203-5476
US

V. Phone/Fax

Practice location:
  • Phone: 336-626-3700
  • Fax: 336-626-6453
Mailing address:
  • Phone: 336-625-2333
  • Fax: 336-625-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP22559
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: