Provider Demographics
NPI:1861853459
Name:PORIYA, RATI (PT)
Entity Type:Individual
Prefix:
First Name:RATI
Middle Name:
Last Name:PORIYA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 S HIGHWAY 77
Mailing Address - Street 2:STE 201
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-4641
Mailing Address - Country:US
Mailing Address - Phone:281-908-6480
Mailing Address - Fax:
Practice Address - Street 1:2211 S HIGHWAY 77 STE 200
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-4641
Practice Address - Country:US
Practice Address - Phone:850-252-1414
Practice Address - Fax:850-388-1455
Is Sole Proprietor?:No
Enumeration Date:2016-03-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT30879225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108205900Medicaid