Provider Demographics
NPI:1831462076
Name:POTTS, AUDREY (PT)
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:
Last Name:POTTS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 593349
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-0217
Mailing Address - Country:US
Mailing Address - Phone:210-226-2101
Mailing Address - Fax:210-226-6445
Practice Address - Street 1:1123 N MAIN AVE
Practice Address - Street 2:STE. 211
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4740
Practice Address - Country:US
Practice Address - Phone:210-226-2101
Practice Address - Fax:210-226-6445
Is Sole Proprietor?:No
Enumeration Date:2012-02-20
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1062263174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB162452Medicare PIN