=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881306652
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTEGRITY REHAB MANAGEMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/23/2022
-----------------------------------------------------
Last Update Date | 10/30/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2336 WISTERIA DRIVE, #420
-----------------------------------------------------
City | SNELLVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30078-6160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 470-809-1581
-----------------------------------------------------
Fax | 470-809-1582
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 252 STRICKLAND PASTURE ROAD
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30233-4019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 470-809-1581
-----------------------------------------------------
Fax | 470-809-1582
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT OFFICE
-----------------------------------------------------
Name | ERIC C. BULL
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 470-809-1581
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2251E1300X
-----------------------------------------------------
Taxonomy Name | Clinical Electrophysiology Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------