Provider Demographics
NPI:1235515370
Name:POTEAT, MARLA
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:
Last Name:POTEAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1561 COMMERCE RD
Mailing Address - Street 2:STE 402
Mailing Address - City:VERONA
Mailing Address - State:VA
Mailing Address - Zip Code:24482-9701
Mailing Address - Country:US
Mailing Address - Phone:540-416-0530
Mailing Address - Fax:540-416-0531
Practice Address - Street 1:1561 COMMERCE RD # 402
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:VA
Practice Address - Zip Code:24482-9701
Practice Address - Country:US
Practice Address - Phone:540-416-0110
Practice Address - Fax:540-416-0531
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305209687225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist