Provider Demographics
NPI:1831376979
Name:PORDUM II, FREDERICK FRANCIS (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:FRANCIS
Last Name:PORDUM II
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 1:3 HILLTOWNE DR
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-3147
Mailing Address - Country:US
Mailing Address - Phone:716-662-5106
Mailing Address - Fax:
Practice Address - Street 1:3 HILLTOWNE DR
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-3147
Practice Address - Country:US
Practice Address - Phone:716-662-5106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18739225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist