Mountain Revival Vail, LLC

Primary specialty

Public Health & General Preventive Medicine PhysicianTaxonomy code 2083P0901X

Legal business name

MOUNTAIN REVIVAL VAIL, LLC

Practice address

2211 N Frontage Rd W
Vail, CO 81657-3937

Phone

(978) 621-4027

NPI assigned

Mar 6, 2025

Last updated

Mar 6, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Pamela Shifrin, MT

Title

Owner

Phone

(978) 621-4027

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1741219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741219200000",
    "number": "1154129815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2211 N FRONTAGE RD W",
            "city": "VAIL",
            "state": "CO",
            "postal_code": "816573937",
            "telephone_number": "978-621-4027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2211 N FRONTAGE RD W",
            "city": "VAIL",
            "state": "CO",
            "postal_code": "816573937",
            "telephone_number": "978-621-4027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN REVIVAL VAIL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-06",
        "last_updated": "2025-03-06",
        "certification_date": "2025-03-06",
        "status": "A",
        "authorized_official_last_name": "SHIFRIN",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "978-621-4027",
        "authorized_official_credential": "MT"
    },
    "taxonomies": [
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• S.Jason Moore, P.A.
• Allison Morgan
• Susanna Morgan, OTR
• Matthew Vincent Morris, PT, DPT, OCS
• Justin Michael Moses, DMD
• Brett Mueller
• Matthew Thomas Mymern, PT
• Tana Jo Naughton, PT
• Elizabeth J Neal, M.A., CCC-SLP
• Nathan Neff, PT, DPT

• Public Health & General Preventive Medicine Physician in Vail, CO
• Providers in Vail, CO by specialty
• Public Health & General Preventive Medicine Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.