NPIMap

Organization Active NPI

Premere Rehab LLC

  • Physical Therapist
  • Marysville, WA
National Provider Identifier
1043098809
Registry record updated Sep 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PREMERE REHAB LLC
Practice address
11015 State Ave
Marysville, WA 98271-7200
Phone
(360) 244-4180
NPI assigned
Sep 21, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tammy McCoy
Title
Credentialing Specialist
Phone
(971) 224-2841

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X

Addresses

Primary practice location

11015 State Ave
Marysville, WA 98271-7200

Mailing address

8100 SW Nyberg St Ste 200
Tualatin, OR 97062-8437
Phone (035) 703-6655

Other names 1

  • Infinity Rehab Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Sante of North Scottsdale47 organizations share this tax ID, including this one

Other organizations with this tax ID 46

Organizations that report the same tax identification number in the National Provider Directory.

View all 46

Locations

11015 State Ave
Marysville, WA 98271
Phone (360) 244-4180

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1695254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695254400000",
    "number": "1043098809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8100 SW NYBERG ST STE 200",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970628437",
            "telephone_number": "035-703-6655",
            "fax_number": "503-570-9155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11015 STATE AVE",
            "city": "MARYSVILLE",
            "state": "WA",
            "postal_code": "982717200",
            "telephone_number": "360-244-4180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMERE REHAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-21",
        "last_updated": "2023-09-21",
        "certification_date": "2023-09-21",
        "status": "A",
        "authorized_official_last_name": "MCCOY",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "971-224-2841"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Infinity Rehab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marysville, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.