Provider Demographics
NPI:1306870365
Name:INTEGRATED REHABILITATION GROUP INC
Entity type:Organization
Organization Name:INTEGRATED REHABILITATION GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER-HAND THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:360-568-7774
Mailing Address - Street 1:1830 BICKFORD AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-1749
Mailing Address - Country:US
Mailing Address - Phone:425-330-0633
Mailing Address - Fax:360-568-7779
Practice Address - Street 1:1830 BICKFORD AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-1749
Practice Address - Country:US
Practice Address - Phone:425-330-0633
Practice Address - Fax:360-568-7779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261Q00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Not Answered225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0179382OtherDEPT. OF LABOR & INDUSTRY
WA8930199OtherL&I CRIME VICTIMS
WA7682230Medicaid
WA9055039Medicaid
WA1182780003OtherDME
WA9055039Medicaid