Provider Demographics
NPI:1669953527
Name:PORTER, EMILY SHANNON (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:SHANNON
Last Name:PORTER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MISS
Other - First Name:EMILY
Other - Middle Name:SHANNON
Other - Last Name:VOGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:100 BERKLEY DR
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-1787
Mailing Address - Country:US
Mailing Address - Phone:513-785-2019
Mailing Address - Fax:
Practice Address - Street 1:100 BERKLEY DR
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-1787
Practice Address - Country:US
Practice Address - Phone:513-785-2019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT017364225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist