Provider Demographics
NPI:1790889855
Name:REJUVENATE LLC
Entity Type:Organization
Organization Name:REJUVENATE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:T
Authorized Official - Last Name:GROVER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:406-677-7722
Mailing Address - Street 1:PO BOX 135
Mailing Address - Street 2:
Mailing Address - City:SEELEY LAKE
Mailing Address - State:MT
Mailing Address - Zip Code:59868-0135
Mailing Address - Country:US
Mailing Address - Phone:406-677-7722
Mailing Address - Fax:406-677-7723
Practice Address - Street 1:3027 HIGHWAY 83
Practice Address - Street 2:
Practice Address - City:SEELEY LAKE
Practice Address - State:MT
Practice Address - Zip Code:59868-0135
Practice Address - Country:US
Practice Address - Phone:406-677-7722
Practice Address - Fax:406-677-7723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1478PT225100000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty