Provider Demographics
NPI:1922670314
Name:POTTER PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:POTTER PHYSICAL THERAPY LLC
Other - Org Name:BENEFIT PHYSICAL THERAPY LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ADRIANA
Authorized Official - Middle Name:NASCIMENTO
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:813-265-3033
Mailing Address - Street 1:5318 VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-4829
Mailing Address - Country:US
Mailing Address - Phone:813-265-3033
Mailing Address - Fax:813-727-7060
Practice Address - Street 1:5318 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-4829
Practice Address - Country:US
Practice Address - Phone:813-265-3033
Practice Address - Fax:727-362-7060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-14
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy