Healthcare Provider Details

I. General information

NPI: 1265800072
Provider Name (Legal Business Name): DANIELLE CHRISTINE POTTS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE CHRISTINE WISSE DPT

II. Dates (important events)

Enumeration Date: 09/10/2015
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2158 NORTHGATE PARK LN STE 200
CHATTANOOGA TN
37415-6911
US

IV. Provider business mailing address

PO BOX 536826
PITTSBURGH PA
15253-6800
US

V. Phone/Fax

Practice location:
  • Phone: 423-254-5461
  • Fax: 800-385-7439
Mailing address:
  • Phone: 616-356-5000
  • Fax: 616-356-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10489
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: