Provider Demographics
NPI:1386627016
Name:POTTS, SHARON S (P T)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:S
Last Name:POTTS
Suffix:
Gender:F
Credentials:P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2152 RENARD CT
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-6756
Mailing Address - Country:US
Mailing Address - Phone:410-353-8308
Mailing Address - Fax:410-897-0220
Practice Address - Street 1:2152 RENARD CT
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-6756
Practice Address - Country:US
Practice Address - Phone:410-353-8308
Practice Address - Fax:410-897-0220
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD165802251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD104SMedicare ID - Type UnspecifiedP.T.