Healthcare Provider Details

I. General information

NPI: 1184343568
Provider Name (Legal Business Name): PREMERE REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 82ND PL
URBANDALE IA
50322-4314
US

IV. Provider business mailing address

8100 SW NYBERG ST STE 200
TUALATIN OR
97062-8437
US

V. Phone/Fax

Practice location:
  • Phone: 913-403-8200
  • Fax:
Mailing address:
  • Phone: 503-570-3665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: LAURA CANTRELL
Title or Position: VP COMMUNITY BASED SERVICES
Credential:
Phone: 360-901-8111