Provider Demographics
NPI:1003628553
Name:PORTER, LYNN RILEY
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:RILEY
Last Name:PORTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CEDARCREST RD
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-1851
Mailing Address - Country:US
Mailing Address - Phone:617-390-4645
Mailing Address - Fax:
Practice Address - Street 1:109 UNIVERSITY SQ
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16541-0002
Practice Address - Country:US
Practice Address - Phone:814-871-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer