Individual
MR. GREGG WESLEY POTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, MPT
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
225100000X
Physical Therapist
Primary
3297
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
331041
—
AZ
Enumeration date
05/24/2005
Last updated
02/05/2017
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