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NPI Code Detail

MEDICARE: INTEGRAL REHABILITATION, LLC

MEDICARE: INTEGRAL REHABILITATION, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QR0400XRehabilitation Clinic/Center
2261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center
3261Q00000XClinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1612080200OTHERACS

General Provider Information

NPI Number : 1306176748
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTEGRAL REHABILITATION, LLC
Provider Business Mailing Address
First Line : 49 E 96TH ST
Second Line :
City : NEW YORK
State : NY
Zip : 10128-0782
Country : US
Telephone Number : 801-696-5257
Fax Number : 801-831-5896
Provider Business Practice Location Address
First Line : 6771 S 900 E
Second Line :
City : MIDVALE
State : UT
Zip : 84047-1436
Country : US
Telephone Number : 801-696-5257
Fax Number : 801-683-1589
Authorized Official
Title or Position : CEO
Name : DR. HALLIE J ROBBINS
Credential : DO
Telephone Number : 801-696-5257
Provider Enumeration Date : 01/07/2010
Last Update Date : 03/16/2022

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Directions to “INTEGRAL REHABILITATION, LLC ” Practice Location

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