Organization
REHAB SPECIALISTS OUTPATIENT LLC
Active
Other names
AgeSTRONG Holladay Park Plaza
Organization subpart
No
Provider details
NPI number
Authorized official
PHILLIP G FOGG JR. (OWNER)
(971) 206-5200
Entity
Organization
Contact information
Practice address
1300 NE 16TH AVE, PORTLAND, OR 97232-1467
(503) 288-6671
Mailing address
4560 SE INTERNATIONAL WAY STE 100, MILWAUKIE, OR 97222-4628
(971) 206-5200
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
08/03/2021
Last updated
08/28/2025
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