# PROVIDENCE SILVERTON REHAB LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PROVIDENCE SILVERTON REHAB LLC
- **Other names:** Silverton Rehabilitation Services
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1659444610
- **Legal business name:** PROVIDENCE SILVERTON REHAB LLC
- **Authorized official:** DANA L MONTGOMERY (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (503) 893-7295

## Contact information

- **Practice address:** 240 PHELPS ST, SILVERTON, OR 97381-1927
- **Practice address phone:** (503) 873-1647
- **Practice address fax:** (503) 779-2234
- **Mailing address:** PO BOX 3290, PORTLAND, OR 97208-3290
- **Mailing address phone:** (503) 215-4323
- **Mailing address fax:** (503) 215-0297

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |
| 225X00000X | Occupational Therapist | — | NULL | — |
| 225X00000X | Occupational Therapist | — | — | — |

## Other

- **Enumeration date:** 11/16/2006
- **Last updated:** 10/01/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | DA5512 | RAILROAD MEDICARE PART B | OR |