Provider Demographics
NPI:1073311742
Name:PORTER, MIA
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:PORTER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 BEECHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6665
Mailing Address - Country:US
Mailing Address - Phone:412-995-8268
Mailing Address - Fax:
Practice Address - Street 1:121 BEECHWOOD DR
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6665
Practice Address - Country:US
Practice Address - Phone:412-995-8268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency