MEDICARE: PREMERE REHAB LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	235Z00000X	Speech-Language Pathologist
3	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1083310551
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMERE REHAB LLC

Provider Business Mailing Address
First Line	:	8100 SW NYBERG ST STE 200
Second Line	:
City	:	TUALATIN
State	:	OR
Zip	:	97062-8437
Country	:	US
Telephone Number	:	503-570-3665
Fax Number	:	503-570-9155

Provider Business Practice Location Address
First Line	:	2800 MIDLAND AVE
Second Line	:
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-4010
Country	:	US
Telephone Number	:	970-945-1121
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	TAMMY MCCOY
Credential	:
Telephone Number	:	503-496-5057

Provider Enumeration Date	:	02/06/2023
Last Update Date	:	02/06/2023

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Directions to “PREMERE REHAB LLC ” Practice Location

Language	Start Address	Practice Location

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