Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
JOHNNA REVIS, PTA
Active Sole ProprietorJOHNNA REVIS, PTA is a Physical Disabilities Residential Treatment Facility healthcare provider located in GRAY COURT, South Carolina. NPI 1205202413 is currently active in the NPPES registry. Verify at CMS.
Physical Disabilities Residential Treatment Facility · GRAY COURT, SC
Registration Details
- NPI Number
- 1205202413
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Aug 12, 2015 (10.823986949618 yrs)
- Last Updated
- Aug 12, 2015
- License
-
1771 (SC)
- Sole Proprietor
- Yes
Practice Information
- Address
-
5768 HIGHWAY 14GRAY COURT, SC, 296456764Browse SC providers · Browse ZIP 29645
- Phone
- 8648722116
- Primary Specialty
-
Physical Disabilities Residential Treatment Facility
320700000X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.