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General NPI Number Information
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NPI Number | 1063860252
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Entity Type | Individual
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Provider Name | KIANDRA POTEAT
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Gender | Female
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Dates
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Enumeration Date | 05/27/2016
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Last Update Date | 05/27/2016
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Provider Practice Location Address
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Address Line | 3452 LAKE LYNDA DR SUITE 200
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City | ORLANDO
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State | FL
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Zip | 32817-1430
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Country | US
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Telephone | 800-774-7785
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Fax |
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Provider Business Mailing Address
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Address Line | 2024 MOUNT VERNON CIR
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City | HARRISBURG
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State | PA
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Zip | 17110-3709
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Country | US
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Telephone | 215-341-3336
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501017172
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License Number State | MI
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