Organization
DIMOND PHYSICAL THERAPY AND PERFORMANCE LAB, LLC
Active
Other names
The KOR
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONNEL T DIMOND PT (DIRECTOR/OWNER)
(503) 810-7264
Entity
Organization
Contact information
Practice address
735 SW 158TH AVE, STE 160, BEAVERTON, OR 97006-4952
(503) 597-0035
(503) 296-2985
Mailing address
735 SW 158TH AVE, STE 160, BEAVERTON, OR 97006-4952
(503) 597-0035
(503) 296-2985
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4750
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
520244000
REGENCE
OR
Enumeration date
02/27/2009
Last updated
01/21/2011
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