# DIMOND PHYSICAL THERAPY AND PERFORMANCE LAB, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The KOR
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184864365
- **Authorized official:** MR. DONNEL T DIMOND PT (DIRECTOR/OWNER)
- **Authorized official phone:** (503) 810-7264

## Contact information

- **Practice address:** 735 SW 158TH AVE, STE 160, BEAVERTON, OR 97006-4952
- **Practice address phone:** (503) 597-0035
- **Practice address fax:** (503) 296-2985
- **Mailing address:** 735 SW 158TH AVE, STE 160, BEAVERTON, OR 97006-4952
- **Mailing address phone:** (503) 597-0035
- **Mailing address fax:** (503) 296-2985

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 4750 | OR | Yes |

## Other

- **Enumeration date:** 02/27/2009
- **Last updated:** 01/21/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 520244000 | REGENCE | OR |