| NPI | 1982617593 |
|---|---|
| Former Name | MARY SUSAN PORTER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1166410) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX 1166410) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2018-07-06 |