Provider Demographics
NPI:1013210996
Name:PORTER, KIMBERLY (LMT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 S RURAL RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-1411
Mailing Address - Country:US
Mailing Address - Phone:480-921-8036
Mailing Address - Fax:480-921-8037
Practice Address - Street 1:2200 S RURAL RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1411
Practice Address - Country:US
Practice Address - Phone:480-921-8036
Practice Address - Fax:480-921-8037
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-02552174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist