Potter, Gregg Wesley

Potter, Gregg Wesley is an individual health care provider with primary practice located at 34301 S Old Black Canyon Hwy Ste 7 , Black Canyon City AZ 85324-9728. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as his primary health care specialty. Potter, Gregg Wesley can be contacted via phone (623) 363-8691.

Contact Information

Primary practice address
34301 S Old Black Canyon Hwy Ste 7 Black Canyon City AZ 85324-9728
Phone: (623) 363-8691
Fax: (928) 212-8727
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 3297 Arizona

Profile Details

NPI number 1710980487
LBN Legal business name Potter, Gregg Wesley
Credentials PT, MPT
Entity Individual
Sole proprietor 1 No
Enumeration date May 24th, 2005
Last updated Feb 5th, 2017 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1710980487 NPPES
Arizona MEDICAID 331041

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