Provider Demographics
NPI:1245700244
Name:INTEGRATED REHAB CONSULTANTS FLORIDA, PLLC
Entity type:Organization
Organization Name:INTEGRATED REHAB CONSULTANTS FLORIDA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:725-710-9237
Mailing Address - Street 1:PO BOX 7410884
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-0884
Mailing Address - Country:US
Mailing Address - Phone:312-635-0973
Mailing Address - Fax:312-635-0050
Practice Address - Street 1:1099 W TOWN PKWY
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPG
Practice Address - State:FL
Practice Address - Zip Code:32714-3845
Practice Address - Country:US
Practice Address - Phone:725-710-9237
Practice Address - Fax:702-975-9560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-03
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103346700Medicaid