Provider Demographics
NPI:1447313143
Name:POTTER, PAUL D (MS, PT)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:D
Last Name:POTTER
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6951 CABLE DR
Mailing Address - Street 2:
Mailing Address - City:MARRIOTTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21104-1143
Mailing Address - Country:US
Mailing Address - Phone:410-795-1164
Mailing Address - Fax:
Practice Address - Street 1:13900 BROMFIELD RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-2293
Practice Address - Country:US
Practice Address - Phone:301-601-4830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19490225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist