Provider Demographics
NPI:1215223862
Name:INTEGRA REHABILITATION PHYSICIANS, PLLC
Entity Type:Organization
Organization Name:INTEGRA REHABILITATION PHYSICIANS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:KANELOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-557-0500
Mailing Address - Street 1:11220 ELM LN STE 102
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-0716
Mailing Address - Country:US
Mailing Address - Phone:704-557-0500
Mailing Address - Fax:704-541-5000
Practice Address - Street 1:11220 ELM LN STE 102
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-0716
Practice Address - Country:US
Practice Address - Phone:704-557-0500
Practice Address - Fax:704-541-5000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty