Provider Demographics
NPI:1528673407
Name:PORTER, JENNIFER GESSLER (DPT, PT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:GESSLER
Last Name:PORTER
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:106 OLD CARRIAGE RD
Mailing Address - Street 2:
Mailing Address - City:PONCE INLET
Mailing Address - State:FL
Mailing Address - Zip Code:32127-6910
Mailing Address - Country:US
Mailing Address - Phone:352-360-3770
Mailing Address - Fax:
Practice Address - Street 1:2174 S RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-2947
Practice Address - Country:US
Practice Address - Phone:386-227-6077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
FLPT36023225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist