Provider Demographics
NPI:1831362284
Name:POTTER-VANHOOGSTRAAT, REBECCA ANN (PT, DPT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:POTTER-VANHOOGSTRAAT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ANN
Other - Last Name:POTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:451 SW SEDGWICK RD
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-6447
Mailing Address - Country:US
Mailing Address - Phone:360-845-1801
Mailing Address - Fax:
Practice Address - Street 1:451 SW SEDGWICK RD
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-6447
Practice Address - Country:US
Practice Address - Phone:360-845-1801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8058225100000X
WAPT61615726225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist