Individual
MRS. DEBRA L PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
4540 MANHATTAN RD, JACKSON, MS 39206-6022
(601) 982-7421
Mailing address
4540 MANHATTAN RD, JACKSON, MS 39206-6022
(601) 982-7421
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT4672
MS
225100000X
Physical Therapist
PT5424
SC
Other
Enumeration date
02/04/2014
Last updated
02/04/2014
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