Healthcare Provider Details

I. General information

NPI: 1578628061
Provider Name (Legal Business Name): MARIA B. POTTS P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 W MAIN ST
BIRDSBORO PA
19508-1900
US

IV. Provider business mailing address

320 W MAIN ST
BIRDSBORO PA
19508-1900
US

V. Phone/Fax

Practice location:
  • Phone: 610-582-2348
  • Fax: 610-582-3938
Mailing address:
  • Phone: 610-582-2348
  • Fax: 610-582-3938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT005885
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: