Provider Demographics
NPI:1538881636
Name:REEVERTS, JAKE K (DPT)
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:K
Last Name:REEVERTS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 E SAINT CLAIR ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-4853
Mailing Address - Country:US
Mailing Address - Phone:812-885-3775
Mailing Address - Fax:812-885-8499
Practice Address - Street 1:332 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:IL
Practice Address - Zip Code:62806-1300
Practice Address - Country:US
Practice Address - Phone:618-445-3669
Practice Address - Fax:618-445-3672
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070028196225100000X
2251S0007X
IN05014258A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports