MEDICARE: MRS. CHRISTINA MARIE PORTER LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	7892	MT
2	225700000X	Massage Therapist	MT.0015295	CO

General Provider Information

NPI Number	:	1427414663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINA MARIE PORTER LMT

Provider Business Mailing Address
First Line	:	1815 9TH AVE W
Second Line	:
City	:	COLUMBIA FALLS
State	:	MT
Zip	:	59912-4358
Country	:	US
Telephone Number	:	406-309-5976
Fax Number	:

Provider Business Practice Location Address
First Line	:	1815 9TH AVE W
Second Line	:
City	:	COLUMBIA FALLS
State	:	MT
Zip	:	59912-4358
Country	:	US
Telephone Number	:	406-309-5976
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2016
Last Update Date	:	01/04/2016

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