Provider Demographics
NPI:1548751746
Name:INTEGRATIVE REHABILITATION MEDICAL LLC
Entity Type:Organization
Organization Name:INTEGRATIVE REHABILITATION MEDICAL LLC
Other - Org Name:INTEGRATIVE RECOVERY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:O'DELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-690-2424
Mailing Address - Street 1:1515 MICHIGAN ST NE STE 115
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2031
Mailing Address - Country:US
Mailing Address - Phone:616-690-2424
Mailing Address - Fax:
Practice Address - Street 1:3012 LAKE WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32934-7613
Practice Address - Country:US
Practice Address - Phone:616-690-2424
Practice Address - Fax:616-825-6139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-23
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment