Individual
MRS. MARY REAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
5423 HAMILTON WOLFE RD, SAN ANTONIO, TX 78229-4344
(210) 547-2500
Mailing address
5423 HAMILTON WOLFE RD, SAN ANTONIO, TX 78229-4344
(210) 547-2500
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2053240
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2053240
STATE LICENSURE
TX
Enumeration date
04/29/2015
Last updated
04/29/2015
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