Individual
DORIS FONG POTTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1102 WINKLER AVE, KILLEEN, TX 76542-6249
(254) 634-8505
(254) 781-4312
Mailing address
605 DONNIE AVE, KILLEEN, TX 76541-8918
(254) 634-8505
(254) 781-4312
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
1207819
TX
2251P0200X
Pediatric Physical Therapist
2717
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
152928721
—
AR
05
—
283205701
—
TX
01
—
56132
BLUE CROSS BLUE SHIELD
AR
Enumeration date
04/25/2007
Last updated
09/11/2017
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