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General NPI Number Information
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NPI Number | 1952181984
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Entity Type | Individual
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Provider Name | KATHLEEN L PORTER LMT
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Gender | Female
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Dates
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Enumeration Date | 10/05/2023
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Last Update Date | 10/05/2023
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Provider Practice Location Address
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Address Line | 10641 E MINNESOTA AVE
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City | SUN LAKES
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State | AZ
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Zip | 85248-8843
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Country | US
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Telephone | 480-322-4981
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Fax |
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Provider Business Mailing Address
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Address Line | 10641 E MINNESOTA AVE
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City | SUN LAKES
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State | AZ
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Zip | 85248-8843
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Country | US
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Telephone | 808-282-3355
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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 | MAT-15262
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License Number State | HI
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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 | MT-25051
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License Number State | AZ
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