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General NPI Number Information
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NPI Number | 1336790146
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Entity Type | Individual
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Provider Name | MADELYNE KAYE PORTER
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Gender | Female
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Dates
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Enumeration Date | 09/23/2019
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 5057 W 3450 S
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City | WEST HAVEN
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State | UT
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Zip | 84401-8826
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Country | US
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Telephone | 757-771-6783
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Fax |
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Provider Business Mailing Address
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Address Line | 4339 S 2350 W
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City | ROY
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State | UT
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Zip | 84067-2013
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Country | US
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Telephone | 757-771-6783
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 9505343-4701
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 148704
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License Number State | AK
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