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Organization
PROVIDENCE SILVERTON REHAB LLC
Active
Organization
PROVIDENCE SILVERTON REHAB LLC
Active
Parent organization
PROVIDENCE SILVERTON REHAB LLC
Other names
Silverton Rehabilitation Services
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE SILVERTON REHAB LLC
Authorized official
DANA L MONTGOMERY (CHIEF FINANCIAL OFFICER)
(503) 893-7295
Entity
Organization
Contact information
Practice address
240 PHELPS ST, SILVERTON, OR 97381-1927
(503) 873-1647
(503) 779-2234
Mailing address
PO BOX 3290, PORTLAND, OR 97208-3290
(503) 215-4323
(503) 215-0297
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
NULL
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
NULL
225X00000X
Occupational Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DA5512
RAILROAD MEDICARE PART B
OR
Enumeration date
11/16/2006
Last updated
10/01/2012
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