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General NPI Number Information
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NPI Number | 1386791903
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Entity Type | Individual
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Provider Name | JEFFERY LYNN POTTHOFF ATC, LAT, CST
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Gender | Male
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 540 MADISON OAK DR SUITE 690
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City | SAN ANTONIO
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State | TX
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Zip | 78258-3943
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Country | US
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Telephone | 210-491-3434
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Fax | 210-496-7746
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Provider Business Mailing Address
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Address Line | 515 SPRINGWOOD LN
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City | ADKINS
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State | TX
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Zip | 78101-2711
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Country | US
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Telephone | 830-217-4472
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT0624
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License Number State | TX
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