Basic Information
| Provider Information | |||||||||
| NPI: | 1417360108 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PORTER | ||||||||
| FirstName: | WARREN | ||||||||
| MiddleName: | CURT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 305 NE LOOP 820 STE 200 | ||||||||
| Address2: | |||||||||
| City: | HURST | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760537211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4693648600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1349 EMPIRE CENTRAL DR STE 516 | ||||||||
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| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752474066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4693648600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2014 | ||||||||
| LastUpdateDate: | 06/10/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0200X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No ID Information.