MEDICARE: SALEM REHABILITATION ASSOCIATES, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316136088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALEM REHABILITATION ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 845
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97308-0845
Country	:	US
Telephone Number	:	503-561-5902
Fax Number	:	503-561-4912

Provider Business Practice Location Address
First Line	:	2561 CENTER ST NE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-4600
Country	:	US
Telephone Number	:	503-561-5902
Fax Number	:	503-561-4912

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ERIK D. BLAKE, MD
Credential	:	MD
Telephone Number	:	503-561-5976

Provider Enumeration Date	:	10/18/2007
Last Update Date	:	12/18/2009

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