Individual
MRS. AMY JO PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
435 PHALEN BLVD, SAINT PAUL, MN 55130-5302
(651) 254-3200
Mailing address
6614 LACASSE DR, LINO LAKES, MN 55038-7703
(651) 235-2070
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A1039
MN
Other
Enumeration date
02/27/2017
Last updated
02/27/2017
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