Provider Demographics
NPI:1427421866
Name:DERVISEVIC, REFIJA
Entity type:Individual
Prefix:
First Name:REFIJA
Middle Name:
Last Name:DERVISEVIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 N CLEVELAND MASSILLON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4558
Mailing Address - Country:US
Mailing Address - Phone:330-668-4041
Mailing Address - Fax:330-666-5626
Practice Address - Street 1:61 N CLEVELAND MASSILLON RD
Practice Address - Street 2:SUITE B
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-4558
Practice Address - Country:US
Practice Address - Phone:330-668-4041
Practice Address - Fax:330-666-5626
Is Sole Proprietor?:No
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.09943225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant