Provider Demographics
NPI:1538150446
Name:POTCOAVA, NICOLAE CATALIN (PT)
Entity type:Individual
Prefix:MR
First Name:NICOLAE
Middle Name:CATALIN
Last Name:POTCOAVA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7418 ROSEBUD BEND DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-3290
Mailing Address - Country:US
Mailing Address - Phone:832-527-6096
Mailing Address - Fax:
Practice Address - Street 1:1200 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:TX
Practice Address - Zip Code:77575-5718
Practice Address - Country:US
Practice Address - Phone:832-527-6096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1141919225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T1025OtherBLUE CROSS BLUE SHEILD
TX1141919OtherP.T. LICENSE NUMBER