Individual
NICHOLAS DALE POTGIESSER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
2600 COMPASS RD, GLENVIEW, IL 60026-8001
(877) 787-3422
Mailing address
59741 WREN LN, SOUTH BEND, IN 46614-4008
(574) 217-5635
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06003315A
IN
Other
Enumeration date
08/10/2020
Last updated
08/10/2020
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