Organization
BLACK CANYON PHYSICAL THERAPY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREGG POTTER PT (MEMBER)
(623) 363-8691
Entity
Organization
Contact information
Practice address
34301 S OLD BLACK CANYON HWY STE 7, BLACK CANYON CITY, AZ 85324-9728
(623) 363-8691
(928) 212-8727
Mailing address
PO BOX 1515, BLACK CANYON CITY, AZ 85324-1515
(623) 363-8691
(928) 212-8727
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
3297
AZ
Other
Enumeration date
10/06/2016
Last updated
02/05/2017
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