Provider Demographics
NPI:1689051658
Name:PROMOTION ADVANCED FUNCTIONAL REHAB, LLC
Entity Type:Organization
Organization Name:PROMOTION ADVANCED FUNCTIONAL REHAB, LLC
Other - Org Name:PROMOTION AFR LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:LARAYNE
Authorized Official - Last Name:ANGLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:503-874-4416
Mailing Address - Street 1:601 N 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:STAYTON
Mailing Address - State:OR
Mailing Address - Zip Code:97383-1704
Mailing Address - Country:US
Mailing Address - Phone:503-769-3123
Mailing Address - Fax:503-769-3176
Practice Address - Street 1:602A FRONT ST
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:OR
Practice Address - Zip Code:97381-2417
Practice Address - Country:US
Practice Address - Phone:503-874-4416
Practice Address - Fax:503-874-4327
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROMOTION ADVANCED FUNTIONAL REHAB, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty