Provider Demographics
NPI:1003535675
Name:PORTO, MICHELLE B
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:B
Last Name:PORTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 RED CREEK DR STE 205A
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-5265
Mailing Address - Country:US
Mailing Address - Phone:585-410-1082
Mailing Address - Fax:
Practice Address - Street 1:125 RED CREEK DR STE 205A
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-5265
Practice Address - Country:US
Practice Address - Phone:585-410-1082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist