Provider Demographics
NPI:1073009163
Name:PORTER, KELLEEN (DPT)
Entity Type:Individual
Prefix:
First Name:KELLEEN
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1871 W WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-2255
Mailing Address - Country:US
Mailing Address - Phone:740-363-4373
Mailing Address - Fax:740-363-9560
Practice Address - Street 1:1871 W WILLIAM ST
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-2255
Practice Address - Country:US
Practice Address - Phone:740-363-4373
Practice Address - Fax:740-363-9560
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist