Provider Demographics
NPI:1518697812
Name:PORTER, WALTER JR
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:
Last Name:PORTER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 S PARKER RD STE 212
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-2921
Mailing Address - Country:US
Mailing Address - Phone:470-729-2149
Mailing Address - Fax:
Practice Address - Street 1:1602 S PARKER RD STE 212
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-2921
Practice Address - Country:US
Practice Address - Phone:470-729-2149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO101Y00000X, 171400000X, 174400000X, 175F00000X, 225400000X, 225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitationGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171400000XOther Service ProvidersHealth & Wellness Coach
No174400000XOther Service ProvidersSpecialist
No175F00000XOther Service ProvidersNaturopath
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner