Provider Demographics
NPI:1255377669
Name:PORADA, THEODORE PHILLIP (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:PHILLIP
Last Name:PORADA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 WILLIAM HILTON PKWY
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29928-3442
Mailing Address - Country:US
Mailing Address - Phone:843-842-3222
Mailing Address - Fax:843-842-3202
Practice Address - Street 1:811 WILLIAM HILTON PKWY
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29928-3442
Practice Address - Country:US
Practice Address - Phone:843-842-3222
Practice Address - Fax:843-842-3202
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5104225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00408074OtherRAILROAD MEDICARE NUMBER
SCP00408074OtherRAILROAD MEDICARE NUMBER
SCQ327767643Medicare PIN