MEDICARE: DR. DOMENICA BETH POTENA PT, DPT

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	PT021010	PA

General Provider Information

NPI Number	:	1720378011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOMENICA BETH POTENA PT, DPT

Provider Business Mailing Address
First Line	:	208 LA COSTA DR
Second Line	:
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-8700
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 POWELL PL # 1441
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37204-3622
Country	:	US
Telephone Number	:	866-719-9611
Fax Number	:

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

Provider Enumeration Date	:	04/08/2011
Last Update Date	:	05/15/2024

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