Provider Demographics
NPI:1457802308
Name:PORTER, LINDSEY (PTA)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 W CITY POINT RD
Mailing Address - Street 2:APARTMENT 122
Mailing Address - City:HOPEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:23860-3762
Mailing Address - Country:US
Mailing Address - Phone:757-788-9176
Mailing Address - Fax:
Practice Address - Street 1:1410 N AUGUSTA ST
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-2401
Practice Address - Country:US
Practice Address - Phone:540-886-6233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-16
Last Update Date:2016-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306604601225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant