Provider Demographics
NPI:1215475116
Name:PORTER, MEGAN (LMT)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 S 950 W
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-4703
Mailing Address - Country:US
Mailing Address - Phone:801-860-5999
Mailing Address - Fax:
Practice Address - Street 1:307 N 300 W STE 301
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-1852
Practice Address - Country:US
Practice Address - Phone:801-897-8711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10134261-4701174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist