Provider Demographics
NPI:1891097895
Name:REVERMANN, JOSHUA (LAC)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:
Last Name:REVERMANN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36208 COUNTY ROAD 4
Mailing Address - Street 2:
Mailing Address - City:SAINT JOESEPH
Mailing Address - State:MN
Mailing Address - Zip Code:56374-4602
Mailing Address - Country:US
Mailing Address - Phone:507-227-5324
Mailing Address - Fax:
Practice Address - Street 1:2001 STOCKINGER DR STE 101
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1243
Practice Address - Country:US
Practice Address - Phone:320-200-3236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN171040225700000X
MN1511171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist