Individual
TERESA POTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
197 STATE ST, BOYNE CITY, MI 49712-1288
(231) 582-6365
Mailing address
811 THOMPSON ST, BOYNE CITY, MI 49712-1317
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
5502004092
MI
2255A2300X
Athletic Trainer
Primary
2601000925
MI
Other
Enumeration date
02/26/2015
Last updated
02/26/2015
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