Provider Demographics
NPI:1407368632
Name:POTTS, KATHRYN (LMT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:POTTS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 W 26TH AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-2430
Mailing Address - Country:US
Mailing Address - Phone:907-301-8316
Mailing Address - Fax:
Practice Address - Street 1:8130 OLD SEWARD HWY STE 103
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-3349
Practice Address - Country:US
Practice Address - Phone:907-522-7466
Practice Address - Fax:907-522-7466
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-27
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK106319225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist