Provider Demographics
NPI:1649549080
Name:PORETTA, PAUL
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:PORETTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 NORMANDY DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-7920
Mailing Address - Country:US
Mailing Address - Phone:978-618-0044
Mailing Address - Fax:
Practice Address - Street 1:542 ALLRED MILL RD
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-2202
Practice Address - Country:US
Practice Address - Phone:336-789-5076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant