Provider Demographics
NPI:1215135975
Name:POTTER, NICHOLAS DANIEL (DPT, ATC)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:DANIEL
Last Name:POTTER
Suffix:
Gender:M
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 ALABAMA AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3102
Mailing Address - Country:US
Mailing Address - Phone:919-451-2565
Mailing Address - Fax:
Practice Address - Street 1:118 CAMERON INDOOR STADIUM
Practice Address - Street 2:BOX 90555
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27708-0001
Practice Address - Country:US
Practice Address - Phone:919-451-2565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100442251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports