Individual
DONNEL T DIMOND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
735 SW 158TH AVE, STE 102, BEAVERTON, OR 97006-4952
(503) 597-0035
(503) 726-5490
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223
(630) 759-9510
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT4750
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4750
PT LICENSE NUMBER
OR
01
—
520244001
REGENCE
OR
Enumeration date
06/11/2006
Last updated
07/21/2016
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