Camille Porter

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

7362653-2401 Issued in UT

Practice address

169 N Gateway Dr Ste 160
Providence, UT 84332-9882

Phone

(435) 799-3111

Fax

(435) 799-3148

NPI assigned

Nov 2, 2009

Sex

Female

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

Enrolled in UT

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Gateway Physical Therapy and Sports RehabGroup PAC ID 1557796232, 5 clinicians

Practice addresses (Care Compare)

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.

• Gateway Physical Therapy and Sports Rehab

  • Physical Therapist
  • Providence, UT
  • NPI 1275098998
  Medicare reassignment Care Compare group NPD
• Flex Physical Therapy

  • Physical Therapist
  • Bothell, WA
  • NPI 1679574479
  NPD (past)
• Physiotherapy Associates, Inc

  • Physical Therapy Clinic/Center
  • Olympia, WA
  • NPI 1689319154
  NPD (past)

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

{
    "created_epoch": "1257120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611792000000",
    "number": "1881920403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "169 N GATEWAY DR STE 160",
            "city": "PROVIDENCE",
            "state": "UT",
            "postal_code": "843329882",
            "telephone_number": "435-799-3111",
            "fax_number": "435-799-3148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "169 N GATEWAY DR STE 160",
            "city": "PROVIDENCE",
            "state": "UT",
            "postal_code": "843329882",
            "telephone_number": "435-799-3111",
            "fax_number": "435-799-3148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTER",
        "first_name": "CAMILLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-11-02",
        "last_updated": "2021-01-28",
        "certification_date": "2021-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT60117603",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "UT",
            "license": "7362653-2401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joshua Allen Peterson, RBT
• Sarah Lynn Peterson, RBT
• Tia Peterson, NP-C
• Whitney Petterborg, RDN
• Sherrie Petty
• Primrose Home Care Inc.
• Primrose Hospice Inc.
• Providence City, LLC
• Providence Dermatology LLC
• Providence PDC PLLC

• All providers in Providence, UT
• Physical Therapist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.