Provider Demographics
NPI:1912138686
Name:POTTS, MARIANNE RENE (MPT)
Entity Type:Individual
Prefix:MS
First Name:MARIANNE
Middle Name:RENE
Last Name:POTTS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1400 N DUTTON AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-7120
Mailing Address - Country:US
Mailing Address - Phone:707-523-2848
Mailing Address - Fax:707-523-2866
Practice Address - Street 1:1400 N DUTTON AVE STE 1
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-7120
Practice Address - Country:US
Practice Address - Phone:707-523-2848
Practice Address - Fax:707-523-2866
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343562251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic