NPIMap

Organization Active NPI

Potentia Therapeutics, LLC

  • Physical Therapist
  • Tampa, FL
National Provider Identifier
1063910982
Registry record updated Apr 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
POTENTIA THERAPEUTICS, LLC
Practice address
2307 S Dale Mabry Hwy Ste F
Tampa, FL 33629-6322
Phone
(813) 374-9508
Fax
(813) 443-5599
NPI assigned
Jan 25, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sherrice Broussard Rose
Title
Owner
Phone
(813) 374-9508

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

2307 S Dale Mabry Hwy Ste F
Tampa, FL 33629-6322

Mailing address

2307 S Dale Mabry Hwy Ste F
Tampa, FL 33629-6322

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180530000933 FL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 6103181888 Receives reassigned benefits from 19 practitioners
Practice locations: Tampa, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 20

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1516838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525046400000",
    "number": "1063910982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2307 S DALE MABRY HWY STE F",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336296322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2307 S DALE MABRY HWY STE F",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336296322",
            "telephone_number": "813-374-9508",
            "fax_number": "813-443-5599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTENTIA THERAPEUTICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-25",
        "last_updated": "2018-04-30",
        "status": "A",
        "authorized_official_last_name": "BROUSSARD ROSE",
        "authorized_official_first_name": "SHERRICE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "813-374-9508"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.