Healthcare Provider Details

I. General information

NPI: 1144560533
Provider Name (Legal Business Name): INTEGRATED REHABILITATION INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2013
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 LEGACY PLZ W
LA PORTE IN
46350-5254
US

IV. Provider business mailing address

504 LEGACY PLZ W
LA PORTE IN
46350-5254
US

V. Phone/Fax

Practice location:
  • Phone: 219-326-7246
  • Fax: 219-326-7234
Mailing address:
  • Phone: 219-326-7246
  • Fax: 219-326-7234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. UJWALA PURANIK PURANIK
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 219-326-7246