Provider Demographics
NPI:1124533237
Name:POTIA, TANZILA (PT)
Entity type:Individual
Prefix:
First Name:TANZILA
Middle Name:
Last Name:POTIA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5730 CORPORATE WAY STE 214
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2032
Mailing Address - Country:US
Mailing Address - Phone:774-218-5585
Mailing Address - Fax:
Practice Address - Street 1:415 NEPONSET AVE STE 2B
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-3169
Practice Address - Country:US
Practice Address - Phone:617-287-2225
Practice Address - Fax:617-287-2224
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22148225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist