Individual
TARA GRACE PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
1480 8TH ST, WEST PLAINS, MO 65775-2010
(417) 926-5699
Mailing address
1480 8TH ST, WEST PLAINS, MO 65775-2010
(417) 926-5699
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
AT1533
KY
2255A2300X
Athletic Trainer
Primary
2020021125
MO
Other
Enumeration date
07/14/2020
Last updated
07/14/2020
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