Provider Demographics
NPI:1487007522
Name:PORTER, JEFF (DPT)
Entity type:Individual
Prefix:DR
First Name:JEFF
Middle Name:
Last Name:PORTER
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 1:9910 E TRENNIE LOOP
Mailing Address - Street 2:APT O4
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-9170
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:809 S CHUGACH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6665
Practice Address - Country:US
Practice Address - Phone:907-746-4373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK113308225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist