Healthcare Provider Details

I. General information

NPI: 1124984570
Provider Name (Legal Business Name): MUSANTE LARON PORTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 E TOWN ST STE 1040
COLUMBUS OH
43215-4774
US

IV. Provider business mailing address

323 E TOWN ST STE 1040
COLUMBUS OH
43215-4774
US

V. Phone/Fax

Practice location:
  • Phone: 614-897-0449
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA014197
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: