Integrative Rehabilitation Medical LLC

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

Legal business name

INTEGRATIVE REHABILITATION MEDICAL LLC

Practice address

3012 Lake Washington Rd
Melbourne, FL 32934-7613

Phone

(616) 690-2424

Fax

(616) 825-6139

NPI assigned

May 23, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Todd Paul O'Dell

Title

Owner/Operator

Phone

(616) 690-2424

Specialties & licenses 1

Addresses

Other names 1

• Integrative Recovery, LLC Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1527033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659484800000",
    "number": "1548751746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 MICHIGAN ST NE STE 115",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032031",
            "telephone_number": "616-690-2424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3012 LAKE WASHINGTON RD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329347613",
            "telephone_number": "616-690-2424",
            "fax_number": "616-825-6139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATIVE REHABILITATION MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-23",
        "last_updated": "2022-08-03",
        "certification_date": "2022-08-03",
        "status": "A",
        "authorized_official_last_name": "O'DELL",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "616-690-2424"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Integrative Recovery, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Customized Equipment (DME) in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Customized Equipment (DME) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.