Individual
JESSICA ELIZABETH PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
5501015929
MI
225100000X
Physical Therapist
Primary
6998
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5501015929
STATE LICENSE
MI
01
—
PT-6998
STATE LICENSE
MS
Enumeration date
03/11/2013
Last updated
03/03/2022
Update your record
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