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Individual

MR. ANTHONY CRAIG PORTWOOD

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
MS, ATC, LAT

Contact information

Practice address
1151 W GRANADA BLVD, ORMOND BEACH, FL 32174-5912
(386) 677-6455
(386) 677-6030
Mailing address
1023 CALLE GRANDE ST, ORMOND BEACH, FL 32174-7445
(386) 677-4651
(386) 677-6030

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AL421
FL

Other

Enumeration date
04/26/2006
Last updated
07/08/2007
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