Provider Demographics
NPI:1558640417
Name:PORTER, MINDY BETH (PT)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:BETH
Last Name:PORTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:BETH
Other - Last Name:NOLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2994 BARNEY RD
Mailing Address - Street 2:
Mailing Address - City:TOUCHET
Mailing Address - State:WA
Mailing Address - Zip Code:99360-9681
Mailing Address - Country:US
Mailing Address - Phone:509-301-4447
Mailing Address - Fax:509-204-9074
Practice Address - Street 1:2994 BARNEY RD
Practice Address - Street 2:
Practice Address - City:TOUCHET
Practice Address - State:WA
Practice Address - Zip Code:99360-9681
Practice Address - Country:US
Practice Address - Phone:509-301-4447
Practice Address - Fax:509-204-9074
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6529225100000X
WAPT60503674225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist