Individual
GENE CASAMERA REAVIS III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CO
Contact information
Practice address
901 S 55TH ST UNIT A2, PHILA, PA 19143-4005
(215) 474-4767
Mailing address
901 S 55TH ST, PHILADELPHIA, PA 19143-4005
(215) 474-4767
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
CO264177
PA
Other
Enumeration date
09/28/2023
Last updated
09/28/2023
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