Individual
TRUDY MARIE POTTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1257 NEWGATE DR, AMMON, ID 83406-4696
(208) 552-9971
Mailing address
1257 NEWGATE DR, AMMON, ID 83406-4696
(208) 552-9971
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
248
ID
Other
Enumeration date
09/04/2006
Last updated
07/08/2007
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