Provider Demographics
NPI:1114700416
Name:PORCELLI, ANNA RAE (DPT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:RAE
Last Name:PORCELLI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:167 PORTERS NECK RD STE 120
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-8043
Mailing Address - Country:US
Mailing Address - Phone:910-821-0211
Mailing Address - Fax:910-821-0222
Practice Address - Street 1:102 AUTUMN HALL DR STE 220
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2057
Practice Address - Country:US
Practice Address - Phone:910-660-8018
Practice Address - Fax:910-660-8078
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP22558225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist