Individual
MR. BROCK EVAN POTTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
515 READ ST, EVANSVILLE, IN 47710-1739
(812) 424-9291
Mailing address
8143 SAIL DR, EVANSVILLE, IN 47715-9108
(269) 720-1336
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36002729A
IN
Other
Enumeration date
10/16/2018
Last updated
10/16/2018
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