Healthcare Provider Details

I. General information

NPI: 1629499975
Provider Name (Legal Business Name): DEANNE PORTERFIELD ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2014
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 E KATHERINE AVE
WASHINGTON PA
15301-3965
US

IV. Provider business mailing address

36 E KATHERINE AVE
WASHINGTON PA
15301-3965
US

V. Phone/Fax

Practice location:
  • Phone: 724-422-9985
  • Fax:
Mailing address:
  • Phone: 724-422-9985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT004088
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT001250
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: