Provider Demographics
NPI:1245342773
Name:S. POTTS AND PROFESSIONALS, INC.
Entity type:Organization
Organization Name:S. POTTS AND PROFESSIONALS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:210-646-8008
Mailing Address - Street 1:1248 AUSTIN HWY STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-4867
Mailing Address - Country:US
Mailing Address - Phone:210-646-8008
Mailing Address - Fax:210-646-8242
Practice Address - Street 1:1248 AUSTIN HWY STE 210
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-4867
Practice Address - Country:US
Practice Address - Phone:210-646-8008
Practice Address - Fax:210-646-8242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX648850000224Z00000X, 2251P0200X, 225200000X, 225XP0200X
235Z00000X, 261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161962901Medicaid
TX2776569OtherAETNA
TX2776569OtherAETNA