Provider Demographics
NPI:1578758793
Name:PORTERA, ROSEMARY V
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:V
Last Name:PORTERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 AUSTRALIAN AVE
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-6635
Mailing Address - Country:US
Mailing Address - Phone:561-842-3213
Mailing Address - Fax:561-863-4362
Practice Address - Street 1:1201 AUSTRALIAN AVE
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-6635
Practice Address - Country:US
Practice Address - Phone:561-842-3213
Practice Address - Fax:561-863-4362
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 2327235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist