Healthcare Provider Details

I. General information

NPI: 1366093627
Provider Name (Legal Business Name): INTEGRATED REHABILITATION GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E COLLEGE WAY
MOUNT VERNON WA
98273-5571
US

IV. Provider business mailing address

4220 132ND ST SE STE 202
MILL CREEK WA
98012-8999
US

V. Phone/Fax

Practice location:
  • Phone: 360-464-4358
  • Fax:
Mailing address:
  • Phone: 425-316-8046
  • Fax: 425-341-9034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE KELLY
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 425-316-8046