Provider Demographics
NPI:1669712121
Name:PIMENTEL-POTAMITIS, SUSAN F (BSPT)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:F
Last Name:PIMENTEL-POTAMITIS
Suffix:
Gender:F
Credentials:BSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-2412
Mailing Address - Country:US
Mailing Address - Phone:978-208-0095
Mailing Address - Fax:978-935-2741
Practice Address - Street 1:278 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-4121
Practice Address - Country:US
Practice Address - Phone:978-452-6633
Practice Address - Fax:978-935-2741
Is Sole Proprietor?:No
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6871225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist