Healthcare Provider Details

I. General information

NPI: 1538577820
Provider Name (Legal Business Name): PETER JAMES POTENA PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2014
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
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 TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT023681
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: