Provider Demographics
NPI:1093816464
Name:POTERALSKI, JEFFREY CHARLES
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:CHARLES
Last Name:POTERALSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6115 CALEB PL
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6824
Mailing Address - Country:US
Mailing Address - Phone:423-505-2567
Mailing Address - Fax:
Practice Address - Street 1:2125 NORTHPOINT BLVD
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4072
Practice Address - Country:US
Practice Address - Phone:423-875-3376
Practice Address - Fax:423-875-3451
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN59972251X0800X
TNPT5997225100000X
GAPT7553225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic