Provider Demographics
NPI:1104370857
Name:PORADA, ANN MARIE (MS, ATC)
Entity Type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:
Last Name:PORADA
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3719 TERRACE ST
Mailing Address - Street 2:PETERSEN EVENTS CENTER
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15261-0001
Mailing Address - Country:US
Mailing Address - Phone:412-383-8506
Mailing Address - Fax:412-383-8555
Practice Address - Street 1:3719 TERRACE ST
Practice Address - Street 2:PETERSEN EVENTS CENTER
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15261-0001
Practice Address - Country:US
Practice Address - Phone:412-383-8506
Practice Address - Fax:412-383-8555
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0038202255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer