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General NPI Number Information
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NPI Number | 1891097895
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Entity Type | Individual
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Provider Name | JOSHUA REVERMANN L.AC.
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Gender | Male
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Dates
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Enumeration Date | 11/23/2010
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 2001 STOCKINGER DR STE 101
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City | SAINT CLOUD
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State | MN
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Zip | 56303-1243
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Country | US
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Telephone | 320-200-3236
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Fax |
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Provider Business Mailing Address
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Address Line | 36208 COUNTY ROAD 4
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City | SAINT JOESEPH
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State | MN
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Zip | 56374-4602
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Country | US
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Telephone | 507-227-5324
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 171040
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 1511
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License Number State | MN
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