Individual
MS. REVA COE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
730 THIMBLE SHOALS BLVD, SUITE 130, NEWPORT NEWS, VA 23606-4562
(757) 873-1554
Mailing address
730 THIMBLE SHOALS BLVD, SUITE 130, NEWPORT NEWS, VA 23606-4562
(757) 873-1554
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306602398
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2306602398
VA STATE LICENSE
VA
Enumeration date
08/28/2007
Last updated
08/28/2007
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