| Organization Name: | INTEGRATED REHABILITATION GROUP PC |
| NPI Number: | 1548294168 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL SHANNON O'KELLEY (PRESIDENT/OWNER) |
| Mailing Address: | 150 126th St Orofino |
| State: | ID US |
| Postal Code: | 835449386 |
| Phone Number: | 2084767105 |
| Fax Number: | 2084767233 |
| NPI Enumeration Date: | 07/10/2006 |
| NPI Last Update Date: | 12/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | PT-1220 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |