Individual
MR. CHARLES CASEY PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
230 AIRLINE RD, COLUMBUS, MS 39702-6348
(662) 327-9404
Mailing address
602 OLD WEST POINT RD, STARKVILLE, MS 39759-2686
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA3245
MS
Other
Enumeration date
02/13/2011
Last updated
02/13/2011
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