Provider Demographics
NPI:1922350156
Name:POTTS, JENNIFER EILEEN (DPT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:EILEEN
Last Name:POTTS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 SNOW AVE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3851
Mailing Address - Country:US
Mailing Address - Phone:509-967-6063
Mailing Address - Fax:509-942-2443
Practice Address - Street 1:615 SNOW AVE
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3851
Practice Address - Country:US
Practice Address - Phone:509-967-6063
Practice Address - Fax:509-942-2443
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA9545225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist