Provider Demographics
NPI:1245431717
Name:PORRAS, MARCOS (PT)
Entity Type:Individual
Prefix:
First Name:MARCOS
Middle Name:
Last Name:PORRAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1282 WILD ROSE DR NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-4310
Mailing Address - Country:US
Mailing Address - Phone:321-676-9033
Mailing Address - Fax:
Practice Address - Street 1:1282 WILD ROSE DR NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-4310
Practice Address - Country:US
Practice Address - Phone:321-676-9033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT9001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY8221Medicare ID - Type UnspecifiedFLORIDA MEDICARE