Provider Demographics
NPI:1003628553
Name:PORTER, LYNN R (MAT, LAT, ATC)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:R
Last Name:PORTER
Suffix:
Gender:F
Credentials:MAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 GROVE STREET
Mailing Address - Street 2:
Mailing Address - City:HENNIKER
Mailing Address - State:NH
Mailing Address - Zip Code:03242
Mailing Address - Country:US
Mailing Address - Phone:617-390-4645
Mailing Address - Fax:603-428-6023
Practice Address - Street 1:14 GROVE STREET
Practice Address - Street 2:
Practice Address - City:HENNIKER
Practice Address - State:NH
Practice Address - Zip Code:03242
Practice Address - Country:US
Practice Address - Phone:603-428-2260
Practice Address - Fax:603-428-6023
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-22
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer