Provider Demographics
NPI:1043370331
Name:POTTS, CHRISTOPHER S (RPT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:S
Last Name:POTTS
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6013 TIMBERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-8170
Mailing Address - Country:US
Mailing Address - Phone:870-216-1650
Mailing Address - Fax:
Practice Address - Street 1:6013 TIMBERWOOD LN
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-8170
Practice Address - Country:US
Practice Address - Phone:870-216-1650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-09
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX218881223G0001X
AR2025225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist