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General NPI Number Information
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NPI Number | 1902427693
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Entity Type | Individual
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Provider Name | MATTHEW POTTER DPT
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Gender | Male
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Dates
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Enumeration Date | 05/04/2020
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 105 MARINER HEALTH WAY STE 213
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32086-3251
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Country | US
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Telephone | 904-217-4259
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Fax | 904-217-4251
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Provider Business Mailing Address
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Address Line | 618 MARISOL DR
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32168-5356
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Country | US
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Telephone | 321-525-0612
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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 | 34853
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License Number State | FL
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