Provider Demographics
NPI:1518293067
Name:PORTER, CHRISTINE R (LMT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:R
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 1:66 OAK ST
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-3839
Mailing Address - Country:US
Mailing Address - Phone:631-972-4933
Mailing Address - Fax:
Practice Address - Street 1:126 E MAIN ST STE 106
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2810
Practice Address - Country:US
Practice Address - Phone:631-459-9254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-19
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022577-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist