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General NPI Number Information
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NPI Number | 1245021955
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Entity Type | Individual
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Provider Name | JEREMIAH M PORTER PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 05/13/2025
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 3445 GOLDEN TRIANGLE BLVD
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City | FORT WORTH
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State | TX
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Zip | 76177-7166
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Country | US
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Telephone | 817-812-3007
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Fax |
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Provider Business Mailing Address
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Address Line | 800 E ASH LN APT 2733
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City | EULESS
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State | TX
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Zip | 76039-5710
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Country | US
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Telephone | 972-854-2699
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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