MEDICARE: GUNNER POTTS

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	41368	FL

General Provider Information

NPI Number	:	1518721109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUNNER POTTS

Provider Business Mailing Address
First Line	:	116 BRANCH DR
Second Line	:
City	:	CHELSEA
State	:	AL
Zip	:	35043-6906
Country	:	US
Telephone Number	:	205-259-9330
Fax Number	:

Provider Business Practice Location Address
First Line	:	1707 NW SAINT LUCIE WEST BLVD STE 188
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34986-2521
Country	:	US
Telephone Number	:	772-878-3322
Fax Number	:

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

Provider Enumeration Date	:	02/13/2024
Last Update Date	:	02/13/2024

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Directions to “ GUNNER POTTS ” Practice Location

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