Provider Demographics
NPI:1386876068
Name:POTVIN, CHRISTOPHER J (ATC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:J
Last Name:POTVIN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8750 TALON LN E
Mailing Address - Street 2:SUITE C
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-6608
Mailing Address - Country:US
Mailing Address - Phone:360-456-1210
Mailing Address - Fax:360-459-9954
Practice Address - Street 1:2755 MOTTMAN RD SW
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-5684
Practice Address - Country:US
Practice Address - Phone:360-352-5077
Practice Address - Fax:360-352-5022
Is Sole Proprietor?:No
Enumeration Date:2009-08-14
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAA1600490242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA069802570OtherBOARD OF CERTIFICATIONS, INC.
WAA160049024OtherSTATE LICENSE