Provider Demographics
NPI:1508681891
Name:PORRO, ALEXANDER MICHAEL
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:MICHAEL
Last Name:PORRO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001 SW 85TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7325
Mailing Address - Country:US
Mailing Address - Phone:786-859-9546
Mailing Address - Fax:
Practice Address - Street 1:9001 SW 85TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7325
Practice Address - Country:US
Practice Address - Phone:786-859-9546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA33759225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant