Provider Demographics
NPI:1609616507
Name:PORTER, DAVID GARRETT (DPT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:GARRETT
Last Name:PORTER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 88TH ST UNIT 4112
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8249
Mailing Address - Country:US
Mailing Address - Phone:801-604-2117
Mailing Address - Fax:
Practice Address - Street 1:1200 VALLEY WEST DR STE 300
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1904
Practice Address - Country:US
Practice Address - Phone:515-440-3439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA123650225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist