MEDICARE: MRS. AUDREY POTTS P.T.

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	174400000X	Specialist	1062263	TX
2	225100000X	Physical Therapist	1062263	TX

General Provider Information

NPI Number	:	1831462076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AUDREY POTTS P.T.

Provider Business Mailing Address
First Line	:	PO BOX 593349
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78259-0217
Country	:	US
Telephone Number	:	210-226-2101
Fax Number	:	210-226-6445

Provider Business Practice Location Address
First Line	:	1123 N MAIN AVE
Second Line	:	STE. 211
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-4740
Country	:	US
Telephone Number	:	210-226-2101
Fax Number	:	210-226-6445

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

Provider Enumeration Date	:	02/20/2012
Last Update Date	:	06/23/2014

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Directions to “ MRS. AUDREY POTTS P.T.” Practice Location

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