# PREMERE REHAB LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407191141
- **Authorized official:** LAURA CANTRELL PT (DIRECTOR OF OUTPATIENT)
- **Authorized official phone:** (360) 901-8111

## Contact information

- **Practice address:** 11520 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-4306
- **Practice address phone:** (503) 698-1613
- **Mailing address:** 25117 SW PARKWAY AVE, SUITE D, WILSONVILLE, OR 97070-9697

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |
| 225X00000X | Occupational Therapist | — | NULL | — |
| 225X00000X | Occupational Therapist | — | — | — |
| 235Z00000X | Speech-Language Pathologist | — | NULL | — |
| 235Z00000X | Speech-Language Pathologist | — | — | — |

## Other

- **Enumeration date:** 12/06/2012
- **Last updated:** 01/02/2013