Provider Demographics
NPI:1174752042
Name:PORKHOVNIK, JANNA (MSPT)
Entity type:Individual
Prefix:MRS
First Name:JANNA
Middle Name:
Last Name:PORKHOVNIK
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:JANNA
Other - Middle Name:
Other - Last Name:KRIVOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:15 WHITNEY ST
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-2936
Mailing Address - Country:US
Mailing Address - Phone:617-424-4760
Mailing Address - Fax:
Practice Address - Street 1:15 WHITNEY ST
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2936
Practice Address - Country:US
Practice Address - Phone:617-424-4760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11475225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist