Active NPI
Premere Rehab LLC
- Physical Therapist
- Lacey, WA
National Provider Identifier
1174861637
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Legal business name
- PREMERE REHAB LLC
- Practice address
- 4532 Intelco Loop SE
Lacey, WA 98503-5561 - Phone
- (360) 528-3253
- NPI assigned
- Jan 17, 2013
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Laura Cantrell, PT
- Title
- Director of Outpatient
- Phone
- (360) 901-8111
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | Primary | ||
| Occupational Therapist | 225X00000X | |||
| Speech-Language Pathologist | 235Z00000X |
Addresses
Primary practice location
4532 Intelco Loop SE
Lacey, WA 98503-5561
Mailing address
25117 SW Parkway Ave
Suite D
Wilsonville, OR 97070-9697
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110526000548 | WA | Part B Supplier - Clinic/Group Practice | 2567434764 |
Receives reassigned benefits from 13 practitioners 25 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Cheney, WA; Yakima, WA; Tacoma, WA; Silverdale, WA; Seattle, WA; Puyallup, WA; Camas, WA; Bothell, WA… |
Other NPIs on the same Medicare enrollment 25
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1358380800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1358380800000",
"number": "1174861637",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25117 SW PARKWAY AVE",
"address_2": "SUITE D",
"city": "WILSONVILLE",
"state": "OR",
"postal_code": "970709697"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4532 INTELCO LOOP SE",
"city": "LACEY",
"state": "WA",
"postal_code": "985035561",
"telephone_number": "360-528-3253"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PREMERE REHAB LLC",
"organizational_subpart": "NO",
"enumeration_date": "2013-01-17",
"last_updated": "2013-01-17",
"status": "A",
"authorized_official_last_name": "CANTRELL",
"authorized_official_first_name": "LAURA",
"authorized_official_title_or_position": "DIRECTOR OF OUTPATIENT",
"authorized_official_telephone_number": "360-901-8111",
"authorized_official_credential": "PT"
},
"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": []
}Other providers in Lacey, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.