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General NPI Number Information
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NPI Number | 1548294168
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Entity Type | Organization
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Legal Business Name | INTEGRATED REHABILITATION GROUP, PC
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 12/28/2023
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Provider Practice Location Address
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Address Line | 150 126TH ST
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City | OROFINO
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State | ID
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Zip | 83544-9386
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Country | US
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Telephone | 208-476-7105
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Fax | 208-476-7233
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Provider Business Mailing Address
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Address Line | 4220 132ND ST SE SUITE 101
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City | MILL CREEK
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State | WA
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Zip | 98012-8999
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Country | US
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Telephone | 425-316-8046
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Fax | 425-338-9637
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MICHAEL SHANNON O'KELLEY
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Credential | MPT
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Telephone | 425-316-8046
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT-1220
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License Number State | ID
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