Organization
INTEGRATED NEUROREHAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEVERY R LARSEN SLP (CEO)
(801) 636-8106
Entity
Organization
Contact information
Practice address
1644 N GENEVA RD, PROVO, UT 84601-1288
(801) 636-8106
Mailing address
1644 N GENEVA RD, PROVO, UT 84601-1288
(801) 636-8106
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
08/12/2019
Last updated
08/12/2019
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