Individual
MRS. SUSAN KAY PORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5778 CHAPIN ST, FLORENCE, WI 54121-9443
(715) 696-3605
(715) 528-4988
Mailing address
213 KUIVILA RD, CRYSTAL FALLS, MI 49920-9675
(906) 875-3786
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1458-19
WI
225200000X
Physical Therapy Assistant
5502001869
MI
Other
Enumeration date
02/15/2013
Last updated
02/15/2013
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