Provider Demographics
NPI:1275861783
Name:PORRITT, DIANE HARVEY (MSPT)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:HARVEY
Last Name:PORRITT
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 S. ALMA SCHOOL ROAD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210
Mailing Address - Country:US
Mailing Address - Phone:480-902-0771
Mailing Address - Fax:480-967-0804
Practice Address - Street 1:1830 S. ALMA SCHOOL ROAD
Practice Address - Street 2:SUITE 130
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210
Practice Address - Country:US
Practice Address - Phone:480-902-0771
Practice Address - Fax:480-967-0804
Is Sole Proprietor?:No
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5231225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist