Healthcare Provider Details

I. General information

NPI: 1164173035
Provider Name (Legal Business Name): INTEGRATED REHABILITATION GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16030 BOTHELL EVERETT HWY STE 140
MILL CREEK WA
98012-1273
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 425-338-9005
  • Fax: 425-337-0931
Mailing address:
  • Phone: 425-316-8046
  • Fax: 425-357-9382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL S OKELLEY
Title or Position: OWNER/PT
Credential: PT
Phone: 425-316-8046