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Individual

MRS. PORTIA MARIE FORE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.T.A.

Contact information

Practice address
1901 N 13TH ST, HERRIN, IL 62948-2839
(618) 942-3274
(618) 942-8240
Mailing address
1901 N 13TH ST, HERRIN, IL 62948-2839
(618) 942-3274
(618) 942-8240

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.004955
IL

Other

Enumeration date
11/13/2008
Last updated
11/13/2008
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