Provider Demographics
NPI:1104867951
Name:INTEGRATED REHABILITATION SERVICES, LLC
Entity Type:Organization
Organization Name:INTEGRATED REHABILITATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:T
Authorized Official - Last Name:PAOLINO
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT, MCTA, ATC
Authorized Official - Phone:860-870-8272
Mailing Address - Street 1:435 HARTFORD TPKE
Mailing Address - Street 2:SUITE U
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4852
Mailing Address - Country:US
Mailing Address - Phone:860-979-1600
Mailing Address - Fax:203-866-3014
Practice Address - Street 1:435 HARTFORD TPK
Practice Address - Street 2:SUITE U
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066
Practice Address - Country:US
Practice Address - Phone:860-875-8272
Practice Address - Fax:860-875-0804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02425Medicare ID - Type Unspecified