Provider Demographics
NPI:1497895239
Name:POTENA, DAVID P (PT, MED)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:P
Last Name:POTENA
Suffix:
Gender:M
Credentials:PT, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 W PENN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEONA
Mailing Address - State:PA
Mailing Address - Zip Code:17042-3201
Mailing Address - Country:US
Mailing Address - Phone:717-270-6078
Mailing Address - Fax:
Practice Address - Street 1:32 W PENN AVE
Practice Address - Street 2:
Practice Address - City:CLEONA
Practice Address - State:PA
Practice Address - Zip Code:17042-3201
Practice Address - Country:US
Practice Address - Phone:717-270-6078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005829L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA515287Medicare ID - Type Unspecified