Provider Demographics
NPI:1588736615
Name:POTTER, JULIA LEA (PT)
Entity type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:LEA
Last Name:POTTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:JULIA
Other - Middle Name:LEA
Other - Last Name:COKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13 OLD TRAHAN PL
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-7013
Mailing Address - Country:US
Mailing Address - Phone:409-466-4514
Mailing Address - Fax:409-227-4717
Practice Address - Street 1:101 CANYON LAKE CIR
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:TX
Practice Address - Zip Code:77657-3701
Practice Address - Country:US
Practice Address - Phone:409-466-4514
Practice Address - Fax:409-227-4717
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1089241225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX107774503Medicaid
TX8T604401OtherBLUE CROSS BLUE SHIELD