Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | A02861 | KY |
NPI | 1447642913 |
---|---|
Provider Name | Tonya Potter |
First Address | Millstone, KY 41838-9091 |
Second Address | Millstone, KY 41838-9091 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2015 |
Last Update Date | 20/02/2015 |