Provider Demographics
NPI:1740373240
Name:PORTER, RUSSELL H (PT)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:H
Last Name:PORTER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2496 MUIR WOODS DR WEST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36693
Mailing Address - Country:US
Mailing Address - Phone:251-232-0009
Mailing Address - Fax:251-661-2357
Practice Address - Street 1:2496 MUIR WOODS DR WEST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36693
Practice Address - Country:US
Practice Address - Phone:251-232-0009
Practice Address - Fax:251-661-2357
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH924225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist