Johnna Revis, PTA

NPI #1205202413 in Gray Court, South Carolina

Provider Information

NPI Number: 1205202413
Entity Type: Individual
Name: Johnna Revis, PTA
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Residential Treatment Facility, Physical Disabilities
Credential: PTA
Enumeration Date: Aug 12, 2015
Last Updated: Aug 12, 2015

Practice Location

Address: 5768 HIGHWAY 14
City: Gray Court
State: South Carolina
ZIP Code: 29645-6764
Phone: (864) 872-2116

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Residential Treatment Facility, Physical Disabilities	320700000X	Primary

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