Healthcare Provider Details

I. General information

NPI: 1316971377
Provider Name (Legal Business Name): INTEGRATED REHABILITATION GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22500 NE MARKETPLACE DR SUITE 204
REDMOND WA
98053-2033
US

IV. Provider business mailing address

1519 132ND ST SE SUITE A
EVERETT WA
98208-7203
US

V. Phone/Fax

Practice location:
  • Phone: 425-836-1034
  • Fax: 425-836-1037
Mailing address:
  • Phone: 425-330-0633
  • Fax: 425-338-9637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL SHANNON O'KELLEY
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: MPT
Phone: 425-337-9556