Individual provider · Type 1 NPI

Jeremy Porter

Massage Therapist · Mishawaka, IN

NPI number 1104730860 Active

Practice location

229 Red Coach Dr Ste 107
Mishawaka, IN 46545-3195

Call (574) 318-7800 Map

Mailing address

21649 Maple Glen Dr
Edwardsburg, MI 49112-9718

Specialties and licenses

TaxonomyCodeLicense
Massage Therapist Primary 225700000XMT22608995 (IN)

Massage Therapist: An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes.

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About NPI 1104730860

Jeremy Porter's National Provider Identifier is 1104730860, issued on Sep 30, 2026. The primary taxonomy on file is Massage Therapist (225700000X), and the practice location is in Mishawaka, IN. The record was last updated on Sep 30, 2026.