Provider Demographics
NPI:1649956475
Name:PORTER, KAITLIN RENEE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:KAITLIN
Middle Name:RENEE
Last Name:PORTER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:RENEE
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 ENOLA RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-4608
Mailing Address - Country:US
Mailing Address - Phone:828-608-6709
Mailing Address - Fax:828-438-6457
Practice Address - Street 1:300 ENOLA RD
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4608
Practice Address - Country:US
Practice Address - Phone:828-608-6709
Practice Address - Fax:828-438-6457
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP22262225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist