Provider Demographics
NPI:1437102977
Name:POTTORFF, ELIZABETH A (LMP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:POTTORFF
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 GRANT RD
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-5243
Mailing Address - Country:US
Mailing Address - Phone:509-884-7163
Mailing Address - Fax:509-884-2363
Practice Address - Street 1:1120 GRANT RD
Practice Address - Street 2:
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-5243
Practice Address - Country:US
Practice Address - Phone:509-884-7163
Practice Address - Fax:509-884-2363
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022464225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist