Healthcare Provider Details

I. General information

NPI: 1487356937
Provider Name (Legal Business Name): INTEGRATED REHABILITATION GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 03/20/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18606 BOTHELL WAY NE
BOTHELL WA
98011-1929
US

IV. Provider business mailing address

4220 132ND ST SE STE 101
MILL CREEK WA
98012-8999
US

V. Phone/Fax

Practice location:
  • Phone: 425-686-7657
  • Fax: 425-606-3192
Mailing address:
  • Phone: 425-316-8046
  • Fax: 425-659-7449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
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: MICHAEL S OKELLEY
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 415-316-8046