Provider Demographics
NPI:1306617386
Name:PORRECO, ANTONIO (DPT)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:PORRECO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 MANNING AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4839
Mailing Address - Country:US
Mailing Address - Phone:541-517-8931
Mailing Address - Fax:
Practice Address - Street 1:8250 WOODMAN AVE BLDG 2
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-5427
Practice Address - Country:US
Practice Address - Phone:818-375-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-10
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist