Provider Demographics
NPI:1871530196
Name:POTAMITIS, GEORGE (PT, DPT, MS)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:POTAMITIS
Suffix:
Gender:M
Credentials:PT, DPT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-4121
Mailing Address - Country:US
Mailing Address - Phone:978-452-6633
Mailing Address - Fax:978-446-9750
Practice Address - Street 1:278 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-4121
Practice Address - Country:US
Practice Address - Phone:978-452-6633
Practice Address - Fax:978-446-9750
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8425225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPOY68029Medicare ID - Type UnspecifiedPROVIDER NUMBER