Provider Demographics
NPI:1538153507
Name:POTENA PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:POTENA PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:POTENA
Authorized Official - Suffix:
Authorized Official - Credentials:PT MED
Authorized Official - Phone:717-270-6078
Mailing Address - Street 1:32 W PENN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEONA
Mailing Address - State:PA
Mailing Address - Zip Code:17042-3201
Mailing Address - Country:US
Mailing Address - Phone:717-270-6078
Mailing Address - Fax:717-270-6094
Practice Address - Street 1:32 W PENN AVE
Practice Address - Street 2:
Practice Address - City:CLEONA
Practice Address - State:PA
Practice Address - Zip Code:17042-3201
Practice Address - Country:US
Practice Address - Phone:717-270-6078
Practice Address - Fax:717-270-6094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADAPT000540208100000X
PAPT005829L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty