Individual
MR. DEREK PORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1 UNIVERSITY DR, UPO #823, CAMPBELLSVILLE, KY 42718-2190
(270) 789-5544
(270) 789-5199
Mailing address
1 UNIVERSITY DR, UPO #823, CAMPBELLSVILLE, KY 42718-2190
(270) 789-5544
(270) 789-5199
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT512
KY
Other
Enumeration date
06/20/2016
Last updated
06/20/2016
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