Provider Demographics
NPI:1215101555
Name:PORRECO, LEONARDO TONY (PT)
Entity type:Individual
Prefix:MR
First Name:LEONARDO
Middle Name:TONY
Last Name:PORRECO
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:3620 NE 122ND AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-1365
Mailing Address - Country:US
Mailing Address - Phone:503-252-4100
Mailing Address - Fax:503-252-3390
Practice Address - Street 1:3620 NE 122ND AVE
Practice Address - Street 2:SUITE C
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-1365
Practice Address - Country:US
Practice Address - Phone:503-252-4100
Practice Address - Fax:503-252-3390
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2015-06-29
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic