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NPI Code Detail

MEDICARE: SECIA PORRECO DPT

MEDICARE:   SECIA  PORRECO  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 : 1801587084
Entity Type Code : Individual
Provider Name (Legal Business Name) : SECIA PORRECO DPT
Provider Business Mailing Address
First Line : 1217 S GREELEY HWY STE A
Second Line :
City : CHEYENNE
State : WY
Zip : 82007-3063
Country : US
Telephone Number : 970-372-1146
Fax Number : 970-223-8219
Provider Business Practice Location Address
First Line : 5320 EDUCATION DR
Second Line :
City : CHEYENNE
State : WY
Zip : 82009-4058
Country : US
Telephone Number : 307-772-0955
Fax Number : 907-772-0953
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2023
Last Update Date : 08/14/2023

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Directions to “ SECIA PORRECO DPT” Practice Location

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