NPIMap

Organization Active NPI

Revived Mobility LLC

  • Physical Medicine & Rehabilitation Physician
  • Post Falls, ID
National Provider Identifier
1336803030
Registry record updated Mar 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
REVIVED MOBILITY LLC
Practice address
2561 W Seltice Way
Post Falls, ID 83854-8093
Phone
(208) 981-0132
NPI assigned
Oct 28, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2024

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

Authorized official

Name
Daniel McGillen
Title
Owner
Phone
(630) 800-9226

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X Primary

Addresses

Primary practice location

2561 W Seltice Way
Post Falls, ID 83854-8093

Mailing address

2561 W Seltice Way
Post Falls, ID 83854-8093
Phone (208) 981-0132

Other names 1

  • Hybrid Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220111000094 ID Part B Supplier - Clinic/Group Practice 7113319898 Receives reassigned benefits from 3 practitioners
Practice locations: Post Falls, ID

National Provider Directory

National Provider Directory

Locations

2561 W Seltice Way
Post Falls, ID 83854
Phone (208) 981-0132

12800 Bothell Everett Hwy
Ste 200
Everett, WA 98208
Phone (206) 259-3122

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1635379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709769600000",
    "number": "1336803030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2561 W SELTICE WAY",
            "city": "POST FALLS",
            "state": "ID",
            "postal_code": "838548093",
            "telephone_number": "208-981-0132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2561 W SELTICE WAY",
            "city": "POST FALLS",
            "state": "ID",
            "postal_code": "838548093",
            "telephone_number": "208-981-0132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVED MOBILITY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-28",
        "last_updated": "2024-03-07",
        "certification_date": "2024-03-07",
        "status": "A",
        "authorized_official_last_name": "MCGILLEN",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "630-800-9226"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hybrid Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Post Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.