Provider Demographics
NPI:1619933652
Name:PORTER, JAMES LEE (ATC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LEE
Last Name:PORTER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:601 WHITNEY RANCH DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2643
Mailing Address - Country:US
Mailing Address - Phone:702-217-5501
Mailing Address - Fax:702-434-9162
Practice Address - Street 1:601 WHITNEY RANCH DR
Practice Address - Street 2:B-6
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2642
Practice Address - Country:US
Practice Address - Phone:702-217-5501
Practice Address - Fax:702-434-9162
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV05060472255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer