MEDICARE: INTEGRATED REHAB GROUP, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1336649789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED REHAB GROUP, INC

Provider Business Mailing Address
First Line	:	2244 E HARMONY RD STE 110
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-3422
Country	:	US
Telephone Number	:	970-226-4244
Fax Number	:	970-226-0251

Provider Business Practice Location Address
First Line	:	2244 E HARMONY RD STE 110
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-3422
Country	:	US
Telephone Number	:	970-226-4244
Fax Number	:	970-226-0251

Authorized Official
Title or Position	:	CFO
Name	:	TARRYN L FARRELL
Credential	:
Telephone Number	:	970-226-1117

Provider Enumeration Date	:	02/12/2018
Last Update Date	:	02/12/2018

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