Provider Demographics
NPI:1144560533
Name:INTEGRATED REHABILITATION INSTITUTE LLC
Entity type:Organization
Organization Name:INTEGRATED REHABILITATION INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:UJWALA PURANIK
Authorized Official - Middle Name:
Authorized Official - Last Name:PURANIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-326-7246
Mailing Address - Street 1:504 LEGACY PLZ W
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-5254
Mailing Address - Country:US
Mailing Address - Phone:219-326-7246
Mailing Address - Fax:219-326-7234
Practice Address - Street 1:504 LEGACY PLZ W
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-5254
Practice Address - Country:US
Practice Address - Phone:219-326-7246
Practice Address - Fax:219-326-7234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine