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NPI Code Detail

MEDICARE: REHAB SPECIALISTS OUTPATIENT LLC

MEDICARE: REHAB SPECIALISTS OUTPATIENT LLC
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
1225100000XPhysical Therapist
2225X00000XOccupational Therapist
3235Z00000XSpeech-Language Pathologist
4261Q00000XClinic/Center

General Provider Information

NPI Number : 1821718008
Entity Type Code : Organization
Provider Name (Legal Business Name) : REHAB SPECIALISTS OUTPATIENT LLC
Provider Business Mailing Address
First Line : 4560 SE INTERNATIONAL WAY STE 100
Second Line :
City : MILWAUKIE
State : OR
Zip : 97222-4628
Country : US
Telephone Number : 503-288-6671
Fax Number :
Provider Business Practice Location Address
First Line : 6720 E GREEN LAKE WAY N
Second Line :
City : SEATTLE
State : WA
Zip : 98103-5439
Country : US
Telephone Number : 206-525-9666
Fax Number :
Authorized Official
Title or Position : OWNER
Name : PHILLIP G FOGG JR.
Credential :
Telephone Number : 971-206-5200
Provider Enumeration Date : 08/30/2022
Last Update Date : 08/28/2025

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Directions to “REHAB SPECIALISTS OUTPATIENT LLC ” Practice Location

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