Provider Demographics
NPI:1699004564
Name:POTTER, HEATHER MARIE (DPT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:POTTER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25251 PASEO DE ALICIA STE 201
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-4616
Mailing Address - Country:US
Mailing Address - Phone:949-716-2730
Mailing Address - Fax:949-716-2733
Practice Address - Street 1:25251 PASEO DE ALICIA STE 201
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653
Practice Address - Country:US
Practice Address - Phone:949-716-2730
Practice Address - Fax:949-716-2733
Is Sole Proprietor?:No
Enumeration Date:2009-12-23
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist