Provider Demographics
NPI:1932131364
Name:REHABILITATION MEDICINE ASSOCIATES, PC
Entity Type:Organization
Organization Name:REHABILITATION MEDICINE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATION PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:K
Authorized Official - Last Name:LAWLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-413-6294
Mailing Address - Street 1:1040 NW 22ND AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3057
Mailing Address - Country:US
Mailing Address - Phone:503-413-6294
Mailing Address - Fax:503-413-7780
Practice Address - Street 1:1040 NW 22ND AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3057
Practice Address - Country:US
Practice Address - Phone:503-413-6294
Practice Address - Fax:503-413-7780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR031740Medicaid
OR031740Medicaid