Michael Porter

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

05012352A Issued in IN

Practice address

601 Richmond Rd N
Berea, KY 40403-8788

Phone

(859) 986-4710

NPI assigned

Mar 19, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1489881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587686400000",
    "number": "1497296743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 HAWTHORNE LN",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461429430",
            "telephone_number": "317-332-9861",
            "fax_number": "317-893-4453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 RICHMOND RD N",
            "city": "BEREA",
            "state": "KY",
            "postal_code": "404038788",
            "telephone_number": "859-986-4710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTER",
        "first_name": "MICHAEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-19",
        "last_updated": "2020-04-24",
        "certification_date": "2020-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05012352A",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KY",
            "license": "006907",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Berea, KY
• Providers in Berea, KY by specialty
• Physical Therapist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.