Individual
MR. WACO C PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11032 S GREEN RD, OLATHE, KS 66061-5657
(816) 547-9654
(816) 832-2874
Mailing address
6713 VERMONT AVE, RAYTOWN, MO 64133-6140
(816) 809-8086
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
14-03569
KS
Other
Enumeration date
02/22/2023
Last updated
02/22/2023
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