MEDICARE: MR. GREGG WESLEY POTTER PT, MPT

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	3297	AZ

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	:	1710980487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GREGG WESLEY POTTER PT, MPT

Provider Business Mailing Address
First Line	:	PO BOX 1515
Second Line	:
City	:	BLACK CANYON CITY
State	:	AZ
Zip	:	85324-1515
Country	:	US
Telephone Number	:	623-363-8691
Fax Number	:	928-212-8727

Provider Business Practice Location Address
First Line	:	34301 S OLD BLACK CANYON HWY STE 7
Second Line	:
City	:	BLACK CANYON CITY
State	:	AZ
Zip	:	85324-9728
Country	:	US
Telephone Number	:	623-363-8691
Fax Number	:	928-212-8727

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	02/05/2017

Similar Medicare Providers

1134679814 — BLACK CANYON PHYSICAL THERAPY, PLLC
Practice Location Address:

34301 S OLD BLACK CANYON HWY STE 7
BLACK CANYON CITY, AZ
85324-9728

Practice Phone: 623-363-8691
Practice Fax: 928-212-8727

1710101894 — MRS. CHERYL ANN MILLER M.S., CCC-SLP
Practice Location Address:

8 TEMPLEDERRY AVE
HAINES CITY, FL
33844-9728

Practice Phone: 863-514-0778
Practice Fax: 863-422-0330

1578724472 — VICTORIA ANN LEMIRE LMFT
Practice Location Address:

3705 W HOWARD CITY EDMORE RD
SIX LAKES, MI
48886-9728

Practice Phone: 713-503-4418
Practice Fax:

1346957917 — CARISSA VANCAMP NP
Practice Location Address:

2445 S 350 W
COLUMBIA CITY, IN
46725-9728

Practice Phone: 260-248-1701
Practice Fax: 260-234-3292

1194719997 — BLACK CANYON FIRE DISTRICT
Practice Location Address:

35050 S OLD BLACK CANYON HWY
BLACK CANYON CITY, AZ
85324-9771

Practice Phone: 623-374-5512
Practice Fax: 623-374-5513

1467432971 — DR. RANDY CHARLES HANCOCK DO
Practice Location Address:

19251 E OASIS DR
BLACK CANYON CITY, AZ
85324-8878

Practice Phone: 623-374-0200
Practice Fax: 623-374-5576

Directions to “ MR. GREGG WESLEY POTTER PT, MPT” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.