Provider Demographics
NPI:1518204908
Name:PORTER PERFORMANCE
Entity Type:Organization
Organization Name:PORTER PERFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:POLLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:540-668-6350
Mailing Address - Street 1:35731 DUNTHORPE LN
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-5225
Mailing Address - Country:US
Mailing Address - Phone:540-668-6350
Mailing Address - Fax:540-668-6350
Practice Address - Street 1:35731 DUNTHORPE LN
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-5225
Practice Address - Country:US
Practice Address - Phone:540-668-6350
Practice Address - Fax:540-668-6350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-06
Last Update Date:2013-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty