Basic Information
| Provider Information | |||||||||
| NPI: | 1104867951 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTEGRATED REHABILITATION SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 435 HARTFORD TPKE | ||||||||
| Address2: | SUITE U | ||||||||
| City: | VERNON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060664852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8609791600 | ||||||||
| FaxNumber: | 2038663014 | ||||||||
| Practice Location | |||||||||
| Address1: | 435 HARTFORD TPK | ||||||||
| Address2: | SUITE U | ||||||||
| City: | VERNON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608758272 | ||||||||
| FaxNumber: | 8608750804 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2006 | ||||||||
| LastUpdateDate: | 02/04/2013 | ||||||||
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| AuthorizedOfficialLastName: | PAOLINO | ||||||||
| AuthorizedOfficialFirstName: | JULIE | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 8608708272 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MS, PT, MCTA, ATC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.