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Organization
PREMERE REHAB LLC
Active
Organization
PREMERE REHAB LLC
Active
Other names
MacKenzie Place FC
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA A CANTRELL PT (DIRECTOR OF OUTPATIENT)
(360) 901-8111
Entity
Organization
Contact information
Practice address
4750 PLEASANT OAK DR, FORT COLLINS, CO 80525-3737
(970) 207-1939
Mailing address
25117 SW PARKWAY AVE, SUITE D, WILSONVILLE, OR 97070-9697
(503) 570-3665
(503) 570-9155
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
COA104421
PTAN
CO
Enumeration date
07/26/2010
Last updated
02/20/2012
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