Provider Demographics
NPI:1477237659
Name:PORRITT, BRAD (HIS)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:
Last Name:PORRITT
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6408 CORTEZ RD W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-2605
Mailing Address - Country:US
Mailing Address - Phone:941-794-3505
Mailing Address - Fax:941-794-8121
Practice Address - Street 1:6408 CORTEZ RD W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-2605
Practice Address - Country:US
Practice Address - Phone:941-794-3505
Practice Address - Fax:941-794-8121
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAST1199237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty