Individual
CARRIE ELIZABETH PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
6177 RIVER CREST DR STE A, RIVERSIDE, CA 92507-0728
(951) 653-4480
(951) 653-5051
Mailing address
6177 RIVER CREST DR STE A, RIVERSIDE, CA 92507-0728
(951) 653-4480
(951) 653-5051
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT298096
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT298096
PT LICENSE
CA
Enumeration date
05/05/2020
Last updated
10/04/2021
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