Provider Demographics
NPI:1447810379
Name:PORTER MOBILE PHYSICAL THERAPY, FITNESS AND GOLF REHAB
Entity type:Organization
Organization Name:PORTER MOBILE PHYSICAL THERAPY, FITNESS AND GOLF REHAB
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JONI
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:901-581-4539
Mailing Address - Street 1:1908 RESTON METRO PLZ APT 1906
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5944
Mailing Address - Country:US
Mailing Address - Phone:901-581-4539
Mailing Address - Fax:
Practice Address - Street 1:1908 RESTON METRO PLZ APT 1906
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5944
Practice Address - Country:US
Practice Address - Phone:901-581-4539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-13
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy