Organization
INTEGRATED REHABILITATION GROUP, PC
Active
Parent organization
INTEGRATED REHABILITATION GROUP, PC
Other names
Riverside Physical Therapy
Organization subpart
Yes
Provider details
NPI number
Legal business name
INTEGRATED REHABILITATION GROUP, PC
Authorized official
MICHAEL SHANNON O'KELLEY MPT (PRESIDENT/OWNER)
(425) 316-8046
Entity
Organization
Contact information
Practice address
150 126TH ST, OROFINO, ID 83544-9386
(208) 476-7105
(208) 476-7233
Mailing address
4220 132ND ST SE, SUITE 101, MILL CREEK, WA 98012-8999
(425) 316-8046
(425) 338-9637
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
PT-1220
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0129413
DEPT. OF LABOR & INDUSTRY
WA
01
—
10022782
REGENCE BLUE SHIELD OF ID
WA
01
—
3791726-06
OWCP
WA
05
—
807710200
—
WA
01
—
CJ3511
RAILROAD MEDICARE
WA
01
—
T9057
BLUE CROSS OF ID
WA
Enumeration date
07/10/2006
Last updated
12/28/2023
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