Provider Demographics
NPI:1275688756
Name:INTERGRO RESOURCES, INC
Entity Type:Organization
Organization Name:INTERGRO RESOURCES, INC
Other - Org Name:INTERGRO REHAB SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHERRILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:TONG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:714-901-4200
Mailing Address - Street 1:1922 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-2610
Mailing Address - Country:US
Mailing Address - Phone:714-901-4200
Mailing Address - Fax:714-903-9425
Practice Address - Street 1:1922 N BROADWAY
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2610
Practice Address - Country:US
Practice Address - Phone:714-901-4200
Practice Address - Fax:714-903-9425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10360225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
BW871AOtherPTAN
CAW15314Medicare ID - Type UnspecifiedMEDICARE NUMBER