Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 570 | TN |
NPI | 1134247547 |
---|---|
Provider Name | Mr. Robert Franklin Potter |
First Address | Johnsoncity, TN 37601 |
Second Address | Mountain Home, TN 37684 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 08/07/2007 |