Individual
MRS. LISA MARIE PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
300 N B ST, EASLEY, SC 29640-2132
(864) 306-3177
Mailing address
300 N B ST, EASLEY, SC 29640-2132
(864) 306-3177
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1313
SC
2251P0200X
Pediatric Physical Therapist
1313
SC
Other
Enumeration date
02/02/2012
Last updated
02/02/2012
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