Provider Demographics
NPI:1558842609
Name:PORNAN, PATRICK R (LPTA)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:R
Last Name:PORNAN
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S LOOP 250 W
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-2134
Mailing Address - Country:US
Mailing Address - Phone:432-689-2100
Mailing Address - Fax:
Practice Address - Street 1:801 S LOOP 250 W
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-2134
Practice Address - Country:US
Practice Address - Phone:432-689-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2048340225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant