Provider Demographics
NPI:1306911433
Name:POTACH, DAVID H (PT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:H
Last Name:POTACH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:12100 W CENTER RD
Mailing Address - Street 2:SUITE 525
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-3969
Mailing Address - Country:US
Mailing Address - Phone:402-330-2774
Mailing Address - Fax:402-330-2779
Practice Address - Street 1:12100 W CENTER RD
Practice Address - Street 2:SUITE 525
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3969
Practice Address - Country:US
Practice Address - Phone:402-330-2774
Practice Address - Fax:402-330-2779
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE17652251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE099668Medicare PIN
NE276203Medicare PIN
NEP19213Medicare UPIN
NE099668010Medicare PIN