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1790931400 NPI number — MANDI LASHEA PORTER PT, DPT

NPI Number: 1790931400
Health Care Provider/Practitioner: MANDI LASHEA PORTER PT, DPT

Information about “1790931400” NPI (MANDI LASHEA PORTER PT, DPT) exists in 1790931400 in HTML format HTML  |  1790931400 in plain Text format TXT  |  1790931400 in PDF (Portable Document Format) PDF  |  1790931400 in an XML format XML  formats.

NPI Number : 1790931400 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1790931400",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PORTER",
    "FirstName": "MANDI",
    "MiddleName": "LASHEA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PT, DPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "STONER",
    "OtherFirstName": "MANDI",
    "OtherMiddleName": "LASHEA",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "PT, DPT",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "4092 MERRILLVILLE DR. APT 14105",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WEST MELBOURNE",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32904",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "707-514-5037",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2520 5TH ST N",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COLUMBUS",
    "PracticeLocationAddressStateName": "MS",
    "PracticeLocationAddressPostalCode": "39705-2008",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "662-244-2074",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/13/2008",
    "LastUpdateDate": "04/15/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": "00010707",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": "5038",
          "LicenseNumberStateCode": "MS",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": "34857",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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