Healthcare Provider Details

I. General information

NPI: 1861988230
Provider Name (Legal Business Name): JARRETT PORTERFIELD DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3109 UNIVERSITY AVE
MORGANTOWN WV
26505-0382
US

IV. Provider business mailing address

625 LINCOLN AVE STE 209
CHARLEROI PA
15022-2451
US

V. Phone/Fax

Practice location:
  • Phone: 304-241-4020
  • Fax: 304-381-2198
Mailing address:
  • Phone: 724-483-2159
  • Fax: 724-489-4758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT003988
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: