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General NPI Number Information
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NPI Number | 1568277721
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Entity Type | Organization
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Legal Business Name | PRESTIGE REHAB OR LLC
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Dates
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Enumeration Date | 02/12/2025
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 5441 S MACADAM AVE STE 4219
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City | PORTLAND
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State | OR
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Zip | 97239-6106
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Country | US
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Telephone | 855-678-8887
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Fax | 855-678-8887
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Provider Business Mailing Address
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Address Line | PO BOX 96276
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City | PHOENIX
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State | AZ
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Zip | 85072-6276
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Country | US
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Telephone | 855-678-8887
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Fax | 855-678-8887
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DANIEL REIZIS
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Credential | PT
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Telephone | 908-670-7573
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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