Provider Demographics
NPI:1225452790
Name:PORTER, DEBRA L (PT)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:L
Last Name:PORTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:DEBRA
Other - Middle Name:L
Other - Last Name:CABRELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4540 MANHATTAN RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-6022
Mailing Address - Country:US
Mailing Address - Phone:601-982-7421
Mailing Address - Fax:
Practice Address - Street 1:4540 MANHATTAN RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-6022
Practice Address - Country:US
Practice Address - Phone:601-982-7421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT4672225100000X
SCPT5424225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist