Provider Demographics
NPI:1306085832
Name:POTGIETER, GEORGINA ALFRIDA
Entity type:Individual
Prefix:MRS
First Name:GEORGINA
Middle Name:ALFRIDA
Last Name:POTGIETER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 4TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SOUTH ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55075-2618
Mailing Address - Country:US
Mailing Address - Phone:651-303-7731
Mailing Address - Fax:
Practice Address - Street 1:770 HIGHWAY 110
Practice Address - Street 2:
Practice Address - City:MENDOTA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55120-1509
Practice Address - Country:US
Practice Address - Phone:651-686-0587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
No173C00000XOther Service ProvidersReflexologist