Provider Demographics
NPI:1336612829
Name:BORTER, EMILY RAE (LMT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:RAE
Last Name:BORTER
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 1:6 N WEST ST STE 1
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:NY
Mailing Address - Zip Code:13077-1068
Mailing Address - Country:US
Mailing Address - Phone:607-591-0052
Mailing Address - Fax:
Practice Address - Street 1:6 N WEST ST STE 1
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:NY
Practice Address - Zip Code:13077-1068
Practice Address - Country:US
Practice Address - Phone:607-591-0052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028029225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist