Provider Demographics
NPI:1346563186
Name:IRL REHAB GROUP LLC
Entity Type:Organization
Organization Name:IRL REHAB GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/ PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:IVY
Authorized Official - Middle Name:
Authorized Official - Last Name:KERNS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:812-887-9484
Mailing Address - Street 1:1071 N BICKNELL RD
Mailing Address - Street 2:
Mailing Address - City:WHEATLAND
Mailing Address - State:IN
Mailing Address - Zip Code:47597-8124
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:325 N GIBSON ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IN
Practice Address - Zip Code:47670-1813
Practice Address - Country:US
Practice Address - Phone:812-887-9484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007933A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty