Provider Demographics
NPI:1114185105
Name:POTTER, ADRIANA NASCIMENTO (PT)
Entity Type:Individual
Prefix:MRS
First Name:ADRIANA
Middle Name:NASCIMENTO
Last Name:POTTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:ADRIANA
Other - Middle Name:LOPES
Other - Last Name:NASCIMENTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5318 VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-4829
Mailing Address - Country:US
Mailing Address - Phone:813-265-3033
Mailing Address - Fax:813-727-7060
Practice Address - Street 1:5318 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-4829
Practice Address - Country:US
Practice Address - Phone:813-265-3033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT34794225100000X, 261QP2000X
IL070016372225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy