Provider Demographics
NPI:1386791903
Name:POTTHOFF, JEFFERY LYNN (ATC, LAT, CST)
Entity type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:LYNN
Last Name:POTTHOFF
Suffix:
Gender:M
Credentials:ATC, LAT, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 SPRINGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ADKINS
Mailing Address - State:TX
Mailing Address - Zip Code:78101-2711
Mailing Address - Country:US
Mailing Address - Phone:830-217-4472
Mailing Address - Fax:
Practice Address - Street 1:540 MADISON OAK DR
Practice Address - Street 2:SUITE 690
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3943
Practice Address - Country:US
Practice Address - Phone:210-491-3434
Practice Address - Fax:210-496-7746
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT06242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer