| Progressive Rehabilitation Associates Llc | |
|
1815 Sw Marlow Ave Suite 110 Portland OR 97225-5185 | |
| (503) 292-0765 | |
| (503) 292-5208 |
| Full Name | Progressive Rehabilitation Associates Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1815 Sw Marlow Ave, Portland, Oregon |
| Authorized Official Name and Position | Heather Wilson (NATIONAL CRED MANAGER) |
| Authorized Official Contact | 5022723463 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Progressive Rehabilitation Associates Llc 1815 Sw Marlow Ave Suite 110 Portland OR 97225-5185 Ph: (503) 292-0765 | Progressive Rehabilitation Associates Llc 1815 Sw Marlow Ave Suite 110 Portland OR 97225-5185 Ph: (503) 292-0765 |
| NPI Number | 1790760908 |
|---|---|
| Provider Enumeration Date | 12/09/2005 |
| Last Update Date | 02/13/2023 |
| Medicare PECOS PAC ID | 3476547258 |
|---|---|
| Medicare Enrollment ID | O20040413001850 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790760908 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Michelle A Kinsella |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1447354527 PECOS PAC ID: 2466534227 Enrollment ID: I20080201000009 |
| Provider Name | Natalie E Boodin |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1124223516 PECOS PAC ID: 5496847865 Enrollment ID: I20090212000432 |
| Provider Name | Darren J Packard |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1245334234 PECOS PAC ID: 2961554316 Enrollment ID: I20090715000345 |
| Provider Name | Gregory Smith |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1427152412 PECOS PAC ID: 9638163413 Enrollment ID: I20120223000996 |
| Provider Name | Thomas B Stason |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1942362199 PECOS PAC ID: 7113196528 Enrollment ID: I20150602001904 |
| Provider Name | Jeanne Renee Tate |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1780026799 PECOS PAC ID: 1759657083 Enrollment ID: I20171031003443 |
| Provider Name | Amy T Monaghan |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1972159507 PECOS PAC ID: 3274961966 Enrollment ID: I20200311001158 |
| Provider Name | Devon L Hordes |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1336525294 PECOS PAC ID: 7517384019 Enrollment ID: I20200824000659 |
| Provider Name | Christine S Kim |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1770258402 PECOS PAC ID: 7315343902 Enrollment ID: I20210907003062 |
| Provider Name | Virginia Rose Gray |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1134737513 PECOS PAC ID: 1658769369 Enrollment ID: I20211029001867 |
| Provider Name | Jodi Gayle Oronsky |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1467614883 PECOS PAC ID: 4688822430 Enrollment ID: I20221019003197 |
| Provider Name | Sage Elizabeth Goodman |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1114624319 PECOS PAC ID: 5395119150 Enrollment ID: I20230316002673 |
| Provider Name | Ricki Bartour |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1194375998 PECOS PAC ID: 8426387465 Enrollment ID: I20230327001541 |
| Provider Name | Debra Jeanne Rollins |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1740989664 PECOS PAC ID: 7214302603 Enrollment ID: I20230418000447 |
| Provider Name | Colin Scott Misich |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1285302182 PECOS PAC ID: 8820463110 Enrollment ID: I20230419002212 |
| Provider Name | Carl Flores |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1538845409 PECOS PAC ID: 1850751496 Enrollment ID: I20230714001248 |
| Provider Name | Colleen Ellen Smagala-devane |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1528588316 PECOS PAC ID: 0143628180 Enrollment ID: I20231116002370 |
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