Provider Demographics
NPI:1619016029
Name:PORTER, ROBIN G (LMP, CMT, CR)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:G
Last Name:PORTER
Suffix:
Gender:F
Credentials:LMP, CMT, CR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 721
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-0721
Mailing Address - Country:US
Mailing Address - Phone:360-794-1971
Mailing Address - Fax:360-805-1785
Practice Address - Street 1:12423 ROBINHOOD LN
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-8686
Practice Address - Country:US
Practice Address - Phone:360-794-1971
Practice Address - Fax:360-805-1785
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00007478225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA91-1897201Medicare UPIN