Individual
ALICIA JOAN PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
900 COOK RD, GROSSE POINTE WOODS, MI 48236-2739
(313) 821-7083
Mailing address
29195 COOLIDGE ST, ROSEVILLE, MI 48066-2208
(586) 615-9482
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
5201007898
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
UNKNOWN
—
MI
Enumeration date
07/25/2018
Last updated
07/25/2018
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