Provider Demographics
NPI:1073684734
Name:POTTER, HILBERT TRACY (PT)
Entity Type:Individual
Prefix:MR
First Name:HILBERT
Middle Name:TRACY
Last Name:POTTER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16400 SNAFFEL BIT CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-8447
Mailing Address - Country:US
Mailing Address - Phone:502-245-7495
Mailing Address - Fax:
Practice Address - Street 1:1227 GOSS AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1239
Practice Address - Country:US
Practice Address - Phone:502-636-1200
Practice Address - Fax:502-636-0351
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY #004263225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist