Healthcare Provider Details

I. General information

NPI: 1881565265
Provider Name (Legal Business Name): INTEGRATED REHAB CONSULTANTS COLORADO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4685 BASELINE RD
BOULDER CO
80303-2601
US

IV. Provider business mailing address

PO BOX 7410886
CHICAGO IL
60674-0884
US

V. Phone/Fax

Practice location:
  • Phone: 312-635-0973
  • Fax: 312-635-0050
Mailing address:
  • Phone: 312-635-0973
  • Fax: 312-635-0050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: AMISH MANU PATEL
Title or Position: CEO
Credential: DO
Phone: 312-635-0973