Provider Demographics
NPI:1568226553
Name:ADVANTAGE PHYSICAL MEDICINE PLLC
Entity Type:Organization
Organization Name:ADVANTAGE PHYSICAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:REVERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-972-0709
Mailing Address - Street 1:397 N PLUM ST
Mailing Address - Street 2:
Mailing Address - City:BREESE
Mailing Address - State:IL
Mailing Address - Zip Code:62230-1528
Mailing Address - Country:US
Mailing Address - Phone:618-526-4700
Mailing Address - Fax:618-526-4702
Practice Address - Street 1:397 N PLUM ST
Practice Address - Street 2:
Practice Address - City:BREESE
Practice Address - State:IL
Practice Address - Zip Code:62230-1528
Practice Address - Country:US
Practice Address - Phone:618-526-4700
Practice Address - Fax:618-526-4702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Multi-Specialty