Provider Demographics
NPI:1104183698
Name:PORTMAN, ADA (PT)
Entity Type:Individual
Prefix:
First Name:ADA
Middle Name:
Last Name:PORTMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 FOREST HILLS DRIVE NE
Mailing Address - Street 2:PRESBYTERIAN HEALTHPLEX
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4137
Mailing Address - Country:US
Mailing Address - Phone:505-923-6400
Mailing Address - Fax:
Practice Address - Street 1:6301 FOREST HILLS DRIVE NE
Practice Address - Street 2:PRESBYTERIAN HEALTHPLEX
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4137
Practice Address - Country:US
Practice Address - Phone:505-923-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2406225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist