Individual
LESLIE REVILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4500 S LANCASTER RD, DALLAS, TX 75216-7167
(214) 742-8387
Mailing address
1213 WARWICK DR, MESQUITE, TX 75150-4332
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
—
—
Other
Enumeration date
02/06/2017
Last updated
02/06/2017
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