Provider Demographics
NPI:1598930323
Name:PORTER, GILLIAN (PT)
Entity type:Individual
Prefix:
First Name:GILLIAN
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N LITCHFIELD RD STE 155
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-1367
Mailing Address - Country:US
Mailing Address - Phone:623-882-9787
Mailing Address - Fax:623-882-9791
Practice Address - Street 1:250 N LITCHFIELD RD STE 155
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-1367
Practice Address - Country:US
Practice Address - Phone:623-882-9787
Practice Address - Fax:623-882-9791
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11596225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist