Healthcare Provider Details

I. General information

NPI: 1699011726
Provider Name (Legal Business Name): INTEGRATED REHABILITATION GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2223 W WELLESLEY AVE STE D
SPOKANE WA
99205-5003
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 509-323-0066
  • Fax: 509-323-0067
Mailing address:
  • Phone: 425-316-8046
  • Fax: 425-659-7449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number710883456
License Number StateWA

VIII. Authorized Official

Name: MICHAEL SHANNON O'KELLEY
Title or Position: PRESIDENT/OWNER
Credential: MPT
Phone: 425-316-8046