Healthcare Provider Details

I. General information

NPI: 1851206767
Provider Name (Legal Business Name): ALEXA PORTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 US HIGHWAY 206
STANHOPE NJ
07874-3274
US

IV. Provider business mailing address

22 ROBESON ST APT 117
SOMERVILLE NJ
08876-3285
US

V. Phone/Fax

Practice location:
  • Phone: 973-446-5024
  • Fax:
Mailing address:
  • Phone: 315-399-8296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02437200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: