Provider Demographics
NPI:1881777837
Name:MT. VIEW REHABILITATION SERVICES, INC.
Entity type:Organization
Organization Name:MT. VIEW REHABILITATION SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BLAISE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOLLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-665-1151
Mailing Address - Street 1:PO BOX 525
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-0125
Mailing Address - Country:US
Mailing Address - Phone:503-665-1151
Mailing Address - Fax:503-669-1986
Practice Address - Street 1:5905 SE POWELL VALLEY RD
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-1919
Practice Address - Country:US
Practice Address - Phone:503-665-1151
Practice Address - Fax:503-669-1986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR237123225100000X
OR229160225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR288505Medicaid