NPI 1205202413

Johnna Revis, PTA

Practitioner Physical Disabilities Residential Treatment Facility Gray Court, SC

Practice location

Address: 5768 Highway 14, Gray Court, SC 29645-6764
Phone: (864) 872-2116

Registered specialties

Physical Disabilities Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320700000X Licence 1771 (SC)

Other Residential Treatment Facility, Physical Disabilities providers in South Carolina →

Registry record

NPI: 1205202413
Entity type: Individual
Sex (as registered): Female
NPI issued: 12 Aug 2015
Record last updated: 12 Aug 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.