Individual
MS. STACY ELLEN POTVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
330 BROOKLINE AVE, BOSTON, MA 02215-5400
(617) 667-4530
Mailing address
330 BROOKLINE AVE, BOSTON, MA 02215-5400
(617) 667-4530
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
3450
MA
Other
Enumeration date
11/04/2010
Last updated
11/04/2010
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