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	:	1821653924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMERE REHAB LLC

Provider Business Mailing Address
First Line	:	25117 SW PARKWAY AVE STE D
Second Line	:
City	:	WILSONVILLE
State	:	OR
Zip	:	97070-9697
Country	:	US
Telephone Number	:	503-570-3665
Fax Number	:	503-570-9155

Provider Business Practice Location Address
First Line	:	1415 N SAN BENITO DR
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85234-2490
Country	:	US
Telephone Number	:	480-842-5541
Fax Number	:

Authorized Official
Title or Position	:	REGIONAL DIRECTOR OF REHAB
Name	:	LAURA CANTRELL
Credential	:
Telephone Number	:	360-901-8111

Provider Enumeration Date	:	05/03/2019
Last Update Date	:	05/03/2019

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Directions to “PREMERE REHAB LLC ” Practice Location

Language	Start Address	Practice Location

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