Provider Demographics
NPI:1245700178
Name:PORCO, KARRI ANN (DPT)
Entity type:Individual
Prefix:
First Name:KARRI
Middle Name:ANN
Last Name:PORCO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KARRI
Other - Middle Name:ANN
Other - Last Name:TOTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:625 KENMOOR AVE SE STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2395
Mailing Address - Country:US
Mailing Address - Phone:269-788-3040
Mailing Address - Fax:269-788-3043
Practice Address - Street 1:710 NORTH AVE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3258
Practice Address - Country:US
Practice Address - Phone:269-788-3040
Practice Address - Fax:269-788-3043
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2025-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016119225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist