Provider Demographics
NPI:1568737872
Name:INTERMOUNTAIN REHABILITATION ASSOCIATES PC
Entity Type:Organization
Organization Name:INTERMOUNTAIN REHABILITATION ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-227-0101
Mailing Address - Street 1:923 W COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-1517
Mailing Address - Country:US
Mailing Address - Phone:719-227-0101
Mailing Address - Fax:719-227-0303
Practice Address - Street 1:923 W COLORADO AVE.
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-1517
Practice Address - Country:US
Practice Address - Phone:719-227-0101
Practice Address - Fax:719-227-0303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty