Healthcare Provider Details

I. General information

NPI: 1659444610
Provider Name (Legal Business Name): PROVIDENCE SILVERTON REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 10/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 PHELPS ST
SILVERTON OR
97381-1927
US

IV. Provider business mailing address

PO BOX 3290
PORTLAND OR
97208-3290
US

V. Phone/Fax

Practice location:
  • Phone: 503-873-1647
  • Fax: 503-779-2234
Mailing address:
  • Phone: 503-215-4323
  • Fax: 503-215-0297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DANA L MONTGOMERY
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 503-893-7295