Healthcare Provider Details

I. General information

NPI: 1699494161
Provider Name (Legal Business Name): SARAH JESSICA POTTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3218 EL CAMINO REAL
ATASCADERO CA
93422-2500
US

IV. Provider business mailing address

4405 CARRIZO RD
ATASCADERO CA
93422-1411
US

V. Phone/Fax

Practice location:
  • Phone: 805-462-1110
  • Fax:
Mailing address:
  • Phone: 805-550-8401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT302746
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: