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Individual

COURTNEY PORTER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PTA

Contact information

Practice address
7 N 600 W, BLACKFOOT, ID 83221-5533
(208) 782-2267
Mailing address
1779 MORNING GLORY LN, POCATELLO, ID 83201-1925
(208) 406-1062

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-2884
ID

Other

Enumeration date
06/10/2013
Last updated
06/10/2013
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