Individual
JEANELLE H. PORTER
Active
Individual
JEANELLE H. PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-001907
KY
2251S0007X
Sports Physical Therapist
PT-001907
KY
2251X0800X
Orthopedic Physical Therapist
PT-001907
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37903705
MEDICAID LAB GROUP
KY
01
—
4000501
MEDICARE LAB GROUP
KY
01
—
650025330
RR MEDICARE PIN
KY
01
—
CB5773
RR MEDICARE GROUP
KY
Enumeration date
11/14/2006
Last updated
12/08/2020
Update your record
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