Provider Demographics
NPI:1023555695
Name:ADVANCED INTEGRATED REHABILITATION, LLC
Entity Type:Organization
Organization Name:ADVANCED INTEGRATED REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:THURSTON
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCMILLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:308-631-8345
Mailing Address - Street 1:2803 GULF TO BAY BLVD
Mailing Address - Street 2:150
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-4014
Mailing Address - Country:US
Mailing Address - Phone:308-631-8345
Mailing Address - Fax:
Practice Address - Street 1:2803 GULF TO BAY BLVD
Practice Address - Street 2:150
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-4014
Practice Address - Country:US
Practice Address - Phone:308-631-8345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1124092081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty