MEDICARE: S. POTTS AND PROFESSIONALS, INC.

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	648850000	TX
2	2251P0200X	Pediatric Physical Therapist	648850000	TX
3	225200000X	Physical Therapy Assistant	648850000	TX
4	225XP0200X	Pediatric Occupational Therapist	648850000	TX
5	235Z00000X	Speech-Language Pathologist
6	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2776569	OTHER	TX	AETNA

NPI Number	:	1245342773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S. POTTS AND PROFESSIONALS, INC.

Provider Business Mailing Address
First Line	:	1248 AUSTIN HWY STE 210
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-4867
Country	:	US
Telephone Number	:	210-646-8008
Fax Number	:	210-646-8242

Provider Business Practice Location Address
First Line	:	1248 AUSTIN HWY STE 210
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-4867
Country	:	US
Telephone Number	:	210-646-8008
Fax Number	:	210-646-8242

Authorized Official
Title or Position	:	OWNER
Name	:	SHARRIE POTTS
Credential	:	OTR
Telephone Number	:	210-646-8008

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	10/28/2020

211 CALLE MORSE
ARROYO, PR
00714-2350

Practice Phone: 787-839-3980
Practice Fax: 787-271-2515