| NPI | 1538431523 |
|---|---|
| Former Legal Business Name | PORTER PERFORMANCE, LLC |
| Entity Type | Organization |
| Authorized Contact | POLLY ANN PORTER President 703-395-3885 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: VA 0110001565) |
| Enumeration Date | 2012-02-06 |
| Last Update Date | 2017-06-28 |