Individual
MICHELLE PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
9501 STATE AVE STE A, MARYSVILLE, WA 98270-2235
(360) 651-8264
(360) 658-9021
Mailing address
9501 STATE AVE STE A, MARYSVILLE, WA 98270-2235
(480) 208-6062
(360) 658-9021
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00018338
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA00018338
MASSAGE LISENCE
WA
Enumeration date
12/10/2014
Last updated
12/10/2014
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