Modern Rehab

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT 2949 Issued in ID

Legal business name

MODERN REHAB

Practice address

745 S Progress Ave
Meridian, ID 83642-5619

Phone

(208) 895-0309

Fax

(208) 895-0311

NPI assigned

Jul 9, 2013

Organization subpart

Yes

Parent organization

REHABAUTHORITY LLC MBRAs reported in NPPES

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

Authorized official

Name

Kevin Hulsey, DPT

Title

President, Ceo

Phone

(208) 288-1155

Specialties & licenses 1

Addresses

Part of

Rehabauthority LLC

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Rehabauthority, LLC

  • Multi-Specialty Clinic/Center
  • Grand Forks, ND
  • NPI 1730159690

  Member Of

  NPD member

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

{
    "created_epoch": "1373328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379462400000",
    "number": "1790126522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1560 S CAROL ST",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836461839",
            "telephone_number": "208-288-1155",
            "fax_number": "208-288-0424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "745 S PROGRESS AVE",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836425619",
            "telephone_number": "208-895-0309",
            "fax_number": "208-895-0311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN REHAB",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "REHABAUTHORITY LLC MBR",
        "enumeration_date": "2013-07-09",
        "last_updated": "2013-09-18",
        "status": "A",
        "authorized_official_last_name": "HULSEY",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "PRESIDENT, CEO",
        "authorized_official_telephone_number": "208-288-1155",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT 2949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Meridian, ID
• Providers in Meridian, ID by specialty
• Physical Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2013; 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.