| Organization Name: | INTEGRA REHABILITATION AGENCY, LLC |
| NPI Number: | 1053414177 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARIA ALICIA SHOOP (ADMINISTRATOR) |
| Mailing Address: | 1013 Riverburch Pkwy Suite 4 Dalton |
| State: | GA US |
| Postal Code: | 307218887 |
| Phone Number: | 7062784438 |
| Fax Number: | 7062267869 |
| NPI Enumeration Date: | 09/06/2006 |
| NPI Last Update Date: | 10/24/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rehabilitation |
| Taxonomy Definition: | |