Provider Demographics
NPI:1144544099
Name:POTTORF, OFRA ALEX (DPT)
Entity type:Individual
Prefix:DR
First Name:OFRA
Middle Name:ALEX
Last Name:POTTORF
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 1:129 BERKELEY AVE
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-1903
Mailing Address - Country:US
Mailing Address - Phone:516-380-9646
Mailing Address - Fax:
Practice Address - Street 1:12 TECHNOLOGY DR UNIT 2
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-4049
Practice Address - Country:US
Practice Address - Phone:631-689-2009
Practice Address - Fax:631-689-2113
Is Sole Proprietor?:No
Enumeration Date:2010-03-22
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032240-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist