Provider Demographics
NPI:1255007407
Name:POTIER, SHAUN STUART (DPT)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:STUART
Last Name:POTIER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:SHAUN
Other - Middle Name:STUART
Other - Last Name:POTGIETER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 MEDICAL PLZ
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-2918
Mailing Address - Country:US
Mailing Address - Phone:870-424-3400
Mailing Address - Fax:870-424-4121
Practice Address - Street 1:3 MEDICAL PLZ
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2918
Practice Address - Country:US
Practice Address - Phone:870-424-3400
Practice Address - Fax:870-424-4121
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT5002225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist