Healthcare Provider Details

I. General information

NPI: 1538153507
Provider Name (Legal Business Name): POTENA PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 W PENN AVE
CLEONA PA
17042-3201
US

IV. Provider business mailing address

32 W PENN AVE
CLEONA PA
17042-3201
US

V. Phone/Fax

Practice location:
  • Phone: 717-270-6078
  • Fax: 717-270-6094
Mailing address:
  • Phone: 717-270-6078
  • Fax: 717-270-6094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberDAPT000540
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPT005829L
License Number StatePA

VIII. Authorized Official

Name: DAVID P POTENA
Title or Position: PRESIDENT
Credential: PT MED
Phone: 717-270-6078