Provider Demographics
NPI:1710735485
Name:PORTER, DAKOTA (PT, DPT)
Entity type:Individual
Prefix:
First Name:DAKOTA
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
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 1:201 SMYTHE ST APT 234
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29611-6347
Mailing Address - Country:US
Mailing Address - Phone:407-820-6695
Mailing Address - Fax:
Practice Address - Street 1:1320 HAMPTON AVENUE EXT STE 11B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-1168
Practice Address - Country:US
Practice Address - Phone:864-900-2975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12320225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist