Individual
MRS. HEATHER ROAN PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1503 LINDELL BLVD, GRANITE CITY, IL 62040-3837
(618) 709-4125
Mailing address
946 CATALINA DR, EDWARDSVILLE, IL 62025-5169
(618) 610-4538
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.008943
IL
225200000X
Physical Therapy Assistant
2020010583
MO
225200000X
Physical Therapy Assistant
PTA-333
ID
Other
Enumeration date
03/04/2006
Last updated
12/13/2022
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