Provider Demographics
NPI:1588901391
Name:PORTER, REBEKAH (LMT)
Entity type:Individual
Prefix:
First Name:REBEKAH
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 1:129 LODGE HALL RD
Mailing Address - Street 2:
Mailing Address - City:NOLENSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37135-7445
Mailing Address - Country:US
Mailing Address - Phone:859-533-4667
Mailing Address - Fax:
Practice Address - Street 1:129 LODGE HALL RD
Practice Address - Street 2:
Practice Address - City:NOLENSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37135-7445
Practice Address - Country:US
Practice Address - Phone:859-533-4667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
326284174N00000X
TN0000014321225700000X
12071374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist