Provider Demographics
NPI:1104153758
Name:POTTER, CAROLINE PAMELA (LMT)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:PAMELA
Last Name:POTTER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 5TH AVE N
Mailing Address - Street 2:SUITE 135
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-7630
Mailing Address - Country:US
Mailing Address - Phone:727-327-2600
Mailing Address - Fax:727-327-2644
Practice Address - Street 1:3160 5TH AVE N
Practice Address - Street 2:SUITE 135
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-7630
Practice Address - Country:US
Practice Address - Phone:727-327-2600
Practice Address - Fax:727-327-2644
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 56117225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist