1578452603 NPI number — MACY MICHELLE PORTERFIELD PT, DPT

Table of content: MACY MICHELLE PORTERFIELD PT, DPT (NPI 1578452603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578452603 NPI number — MACY MICHELLE PORTERFIELD PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PORTERFIELD
Provider First Name:
MACY
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VIA
Provider Other First Name:
MACY
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578452603
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/12/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2650
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COPPELL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75019-8607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-724-2400
Provider Business Mailing Address Fax Number:
972-724-2495

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8876 SYNERGY DR STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCKINNEY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75070-1276
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-793-7166
Provider Business Practice Location Address Fax Number:
469-502-7242
Provider Enumeration Date:
07/02/2025

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1406965 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)