Provider Demographics
NPI:1043512676
Name:PORRO, ALEX ERIC (LMT, MMP)
Entity Type:Individual
Prefix:MR
First Name:ALEX
Middle Name:ERIC
Last Name:PORRO
Suffix:
Gender:M
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6430 LENCZYK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-2589
Mailing Address - Country:US
Mailing Address - Phone:904-294-2209
Mailing Address - Fax:
Practice Address - Street 1:9700 PHILIPS HWY
Practice Address - Street 2:SUITE 107
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-1380
Practice Address - Country:US
Practice Address - Phone:904-294-2209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA47015225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist