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1023111317
REVAJO S. BROADWATER
VALDOSTA, GA
NPI
1023111317
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
225100000X Physical Therapist
(Licence: GA 1473)
Enumeration Date
2006-09-05
Last Update Date
2007-07-08
Business Address
-- REVAJO S. BROADWATER PT
3537 NORTH CROSSING CIRCLE
VALDOSTA, GA 31602
Phone number: 229-333-0095
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Mailing Address
-- REVAJO S. BROADWATER PT
3537 NORTH CROSSING CIRCLE
VALDOSTA, GA 31602
Phone number: 229-333-0095
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