Provider Demographics
NPI:1801599253
Name:POTTS, MARINA LYNN (PT, DPT)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:LYNN
Last Name:POTTS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2875 LAYNE DR
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-1192
Mailing Address - Country:US
Mailing Address - Phone:901-605-4986
Mailing Address - Fax:
Practice Address - Street 1:6760 GOODMAN RD STE 115
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-7056
Practice Address - Country:US
Practice Address - Phone:901-507-5566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS7461225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist