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NPI Code Detail

MEDICARE: KELLEEN PORTER DPT

MEDICARE: KELLEEN PORTER DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist

General Provider Information

NPI Number : 1073009163
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLEEN PORTER DPT
Provider Business Mailing Address
First Line : 1871 W WILLIAM ST
Second Line :
City : DELAWARE
State : OH
Zip : 43015-2255
Country : US
Telephone Number : 740-363-4373
Fax Number : 740-363-9560
Provider Business Practice Location Address
First Line : 1871 W WILLIAM ST
Second Line :
City : DELAWARE
State : OH
Zip : 43015-2255
Country : US
Telephone Number : 740-363-4373
Fax Number : 740-363-9560
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2018
Last Update Date : 12/20/2023

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Directions to “ KELLEEN PORTER DPT” Practice Location

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