Provider Demographics
NPI:1154733715
Name:IPA INTEGRATED REHAB, INC.
Entity type:Organization
Organization Name:IPA INTEGRATED REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:FREDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-784-0320
Mailing Address - Street 1:2315 RUTH HENTZ AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-2260
Mailing Address - Country:US
Mailing Address - Phone:850-784-0320
Mailing Address - Fax:850-784-3661
Practice Address - Street 1:2315 RUTH HENTZ AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-2260
Practice Address - Country:US
Practice Address - Phone:850-784-0320
Practice Address - Fax:850-784-3661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy