Healthcare Provider Details

I. General information

NPI: 1306176748
Provider Name (Legal Business Name): INTEGRAL REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2010
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6771 S 900 E
MIDVALE UT
84047-1436
US

IV. Provider business mailing address

49 E 96TH ST
NEW YORK NY
10128-0782
US

V. Phone/Fax

Practice location:
  • Phone: 801-696-5257
  • Fax: 801-683-1589
Mailing address:
  • Phone: 801-696-5257
  • Fax: 801-831-5896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HALLIE J ROBBINS
Title or Position: CEO
Credential: DO
Phone: 801-696-5257