Individual provider Active NPI

Tanzila Potia, PT

  • Physical Therapist
  • Dorchester, MA
National Provider Identifier
1124533237
Registry record updated Oct 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
22148 Issued in MA
Practice address
415 Neponset Ave Ste 2B
Dorchester, MA 02122-3169
Phone
(617) 287-2225
Fax
(617) 287-2224
NPI assigned
Dec 12, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 22148 MA Primary

Addresses

Primary practice location

415 Neponset Ave Ste 2B
Dorchester, MA 02122-3169

Mailing address

5730 Corporate Way Ste 214
West Palm Beach, FL 33407-2032
Phone (774) 218-5585

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190723003738 MA Practitioner - Physical Therapist in Private Practice 7012243454 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
22148MAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Atlantis Physical Therapy Group,Inc, Physical Therapist PastSince Feb 18, 2005 Accepting new patients
Elmwood Orthopedic Rehab Center, Inc. Physical Therapist Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1513036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602460800000",
    "number": "1124533237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5730 CORPORATE WAY STE 214",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334072032",
            "telephone_number": "774-218-5585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 NEPONSET AVE STE 2B",
            "city": "DORCHESTER",
            "state": "MA",
            "postal_code": "021223169",
            "telephone_number": "617-287-2225",
            "fax_number": "617-287-2224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTIA",
        "first_name": "TANZILA",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-12",
        "last_updated": "2020-10-12",
        "certification_date": "2020-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "22148",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dorchester, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2020; 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.