Healthcare Provider Details

I. General information

NPI: 1063017499
Provider Name (Legal Business Name): GRIT MOBILITY CONCEPTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 02/20/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 E FLOATING FEATHER RD
EAGLE ID
83616-4005
US

IV. Provider business mailing address

430 E FLOATING FEATHER RD
EAGLE ID
83616-4005
US

V. Phone/Fax

Practice location:
  • Phone: 208-918-0830
  • Fax:
Mailing address:
  • Phone: 208-992-7550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANN PHILLIPS
Title or Position: PT/OWNER
Credential: PT,DPT,NCS,CBIS
Phone: 208-992-7550