Provider Demographics
NPI:1386146447
Name:PORRETTA, DARIA (PT DPT)
Entity type:Individual
Prefix:
First Name:DARIA
Middle Name:
Last Name:PORRETTA
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 S DELSEA DR
Mailing Address - Street 2:PMB 144
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-4550
Mailing Address - Country:US
Mailing Address - Phone:609-513-8330
Mailing Address - Fax:
Practice Address - Street 1:29 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-1229
Practice Address - Country:US
Practice Address - Phone:609-502-2006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-05
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01689500225100000X
PAPT026771225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist