MEDICARE: PAUL W POTOS PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	4570-024	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487676870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL W POTOS PT

Provider Business Mailing Address
First Line	:	1300 S GREEN BAY RD STE 205
Second Line	:
City	:	MOUNT PLEASANT
State	:	WI
Zip	:	53406-4469
Country	:	US
Telephone Number	:	262-898-3930
Fax Number	:	262-321-0242

Provider Business Practice Location Address
First Line	:	3840 N OAKLAND AVE
Second Line	:
City	:	SHOREWOOD
State	:	WI
Zip	:	53211-2239
Country	:	US
Telephone Number	:	414-962-8480
Fax Number	:	414-962-8476

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	07/09/2021

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Directions to “ PAUL W POTOS PT” Practice Location

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