Healthcare Provider Details

I. General information

NPI: 1790889855
Provider Name (Legal Business Name): REJUVENATE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3027 HIGHWAY 83
SEELEY LAKE MT
59868-0135
US

IV. Provider business mailing address

PO BOX 135
SEELEY LAKE MT
59868-0135
US

V. Phone/Fax

Practice location:
  • Phone: 406-677-7722
  • Fax: 406-677-7723
Mailing address:
  • Phone: 406-677-7722
  • Fax: 406-677-7723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1478PT
License Number StateMT

VIII. Authorized Official

Name: KIMBERLEY T GROVER
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: MPT
Phone: 406-677-7722