Jaylon J Porter, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1182530 Issued in TX

Practice address

4416 Twin City Blvd
Temple, TX 76502-5818

Phone

(254) 399-8255

NPI assigned

Jun 13, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Heart of Texas Region MHMR Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Waco, TX
  • NPI 1639399132
  Medicare reassignment NPD
• Elite Therapy Services, LLC

  • Occupational Therapist
  • Waco, TX
  • NPI 1891967717
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674691200000",
    "number": "1194768622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10125 T BURY LANE",
            "city": "WACO",
            "state": "TX",
            "postal_code": "76708",
            "telephone_number": "479-857-4212",
            "fax_number": "479-857-4212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4416 TWIN CITY BLVD",
            "city": "TEMPLE",
            "state": "TX",
            "postal_code": "765025818",
            "telephone_number": "254-399-8255"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "601 W Loop 340",
            "address_purpose": "LOCATION",
            "city": "Waco",
            "state": "TX",
            "postal_code": "767126840",
            "country_code": "US",
            "telephone_number": "254-399-8255",
            "fax_number": "254-235-3408",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PORTER",
        "first_name": "JAYLON",
        "middle_name": "J",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-13",
        "last_updated": "2023-01-26",
        "certification_date": "2023-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1182530",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "159238721",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "5Y811",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deepa Ponnusamy, M.D.,
• Sandra Porche
• Port for the Sole Podiatry PLLC
• Andrew Wade Porter, MD
• Emily Ann Porter, M.D.
• Wendell Keith Porter, RDH
• Tara Rachelle Porterlivesay, CPM, LM
• Juan G. Posada, M.D.
• Matthew Neal Posey
• Herman B. Poteet, MD

• Physical Therapist in Temple, TX
• Providers in Temple, TX by specialty
• Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.