NPIMap

Organization Active NPI

Integrated Rehabilitation Group, PC

Doing business as IRG Physical Therapy - Gateway

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Mill Creek, WA
National Provider Identifier
1639513419
Registry record updated Dec 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X
Legal business name
INTEGRATED REHABILITATION GROUP, PC
Doing business as
IRG Physical Therapy - Gateway
Practice address
4220 132ND St SE
Suite 101
Mill Creek, WA 98012-8994
Phone
(425) 316-8046
Fax
(425) 338-9637
NPI assigned
Apr 23, 2013
Organization subpart
Yes
Parent organization
INTEGRATED REHABILITATION GROUP, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 28, 2023

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

Authorized official

Name
Michael Shannon Okelley, MPT
Title
Owner
Phone
(425) 316-8046

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X WA Primary

Addresses

Primary practice location

4220 132ND St SE
Suite 101
Mill Creek, WA 98012-8994

Mailing address

4220 132ND St SE
Suite 101
Mill Creek, WA 98012-8999
Phone (425) 357-9380

Other names 1

  • IRG Physical Therapy - Gateway Doing business as

National Provider Directory

National Provider Directory
Part of
Integrated Rehab Group Inc

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1366675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703721600000",
    "number": "1639513419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4220 132ND ST SE",
            "address_2": "SUITE 101",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "980128999",
            "telephone_number": "425-357-9380",
            "fax_number": "425-357-9380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4220 132ND ST SE",
            "address_2": "SUITE 101",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "980128994",
            "telephone_number": "425-316-8046",
            "fax_number": "425-338-9637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED REHABILITATION GROUP, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INTEGRATED REHABILITATION GROUP, PC",
        "enumeration_date": "2013-04-23",
        "last_updated": "2023-12-28",
        "certification_date": "2023-12-28",
        "status": "A",
        "authorized_official_last_name": "OKELLEY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "SHANNON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "425-316-8046",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IRG Physical Therapy - Gateway",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mill Creek, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2023; 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.