Provider Demographics
NPI:1841435575
Name:REVOIR, JEAN EVELYN (PT)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:EVELYN
Last Name:REVOIR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 JOYCE LN
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-4322
Mailing Address - Country:US
Mailing Address - Phone:419-304-7727
Mailing Address - Fax:
Practice Address - Street 1:1216 JOYCE LN
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-4322
Practice Address - Country:US
Practice Address - Phone:419-304-7727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH003816225100000X
MI5501003144225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist