Individual
MANDY MARIE POTTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10835-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10835-024
DR OF PHYSICAL THERAPY
WI
Enumeration date
08/21/2007
Last updated
08/28/2007
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