Individual
MR. MICHAEL SHAWN PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
401 SUSQUEHANNA AVE, LOCK HAVEN UNIVERSITY, LOCK HAVEN, PA 17745
(570) 893-2197
Mailing address
268 DRY RUN RD, BEECH CREEK, PA 16822-8028
(570) 726-2295
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
RT-000866-A
PA
Other
Enumeration date
10/23/2006
Last updated
07/08/2007
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