Provider Demographics
NPI:1881921609
Name:POTTS, MARY BETH (DPT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:POTTS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 SHAMROCK DR STE 100-102
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-7325
Mailing Address - Country:US
Mailing Address - Phone:812-475-3494
Mailing Address - Fax:812-475-3494
Practice Address - Street 1:4900 SHAMROCK DR STE 10-102
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-7325
Practice Address - Country:US
Practice Address - Phone:812-475-3494
Practice Address - Fax:812-475-3494
Is Sole Proprietor?:No
Enumeration Date:2009-11-16
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05009965A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist