Provider Demographics
NPI:1477588010
Name:INTEGRATED REHABILITATION GROUP, PC
Entity Type:Organization
Organization Name:INTEGRATED REHABILITATION GROUP, PC
Other - Org Name:SOUTH SOUND PHYSICAL & HAND THERAPY-LACEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:OKELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-316-8046
Mailing Address - Street 1:4220 132ND ST SE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-8999
Mailing Address - Country:US
Mailing Address - Phone:425-357-9380
Mailing Address - Fax:425-357-9382
Practice Address - Street 1:5215 CORPORATE CENTER CT SE STE D
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-5800
Practice Address - Country:US
Practice Address - Phone:360-455-8155
Practice Address - Fax:360-455-1655
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRATED REHABILITATION GROUP, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-12
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3583413-02OtherOWCP
WA5621900001Medicare NSC