| Organization Name: | PROMOTION ADVANCED FUNCTIONAL REHAB LLC |
| NPI Number: | 1710932710 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CARMEN LARAYNE ANGLIN (PT MANAGER) |
| Mailing Address: | 601 N 1st St Stayton |
| State: | OR US |
| Postal Code: | 97383 |
| Phone Number: | 5037693123 |
| Fax Number: | 5037693176 |
| NPI Enumeration Date: | 05/24/2006 |
| NPI Last Update Date: | 04/22/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251X0800X |
| License Number: | 4435 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OR |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Orthopedic |
| Taxonomy Definition: | |