Provider Demographics
NPI:1063017499
Name:GRIT MOBILITY CONCEPTS, LLC
Entity Type:Organization
Organization Name:GRIT MOBILITY CONCEPTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT,NCS,CBIS
Authorized Official - Phone:208-992-7550
Mailing Address - Street 1:430 E FLOATING FEATHER RD
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-4005
Mailing Address - Country:US
Mailing Address - Phone:208-992-7550
Mailing Address - Fax:
Practice Address - Street 1:430 E FLOATING FEATHER RD
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-4005
Practice Address - Country:US
Practice Address - Phone:208-918-0830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-03
Last Update Date:2021-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID3656OtherPT LICENSE