Provider Demographics
NPI:1962522441
Name:POTTER, CYNTHIA N (PT)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:N
Last Name:POTTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10069 GRUBBS RD
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9647
Mailing Address - Country:US
Mailing Address - Phone:724-935-7438
Mailing Address - Fax:724-933-0571
Practice Address - Street 1:10069 GRUBBS RD
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9647
Practice Address - Country:US
Practice Address - Phone:724-935-7438
Practice Address - Fax:724-933-0571
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-003689-L2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics