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General NPI Number Information
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NPI Number | 1730722323
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Entity Type | Individual
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Provider Name | PATRICK POTTER
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Gender | Male
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Dates
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Enumeration Date | 10/25/2019
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Last Update Date | 10/25/2019
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Provider Practice Location Address
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Address Line | 3802 AUBURN WAY N STE 301
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City | AUBURN
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State | WA
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Zip | 98002-1400
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Country | US
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Telephone | 253-886-5016
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Fax |
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Provider Business Mailing Address
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Address Line | 510 A ST NE
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City | AUBURN
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State | WA
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Zip | 98002-4027
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Country | US
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Telephone | 253-347-8622
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 60912032
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License Number State | WA
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