NPIMap

Organization Active NPI

Dimond Physical Therapy and Performance Lab, LLC

Doing business as The KOR

  • Physical Therapist
  • Beaverton, OR
National Provider Identifier
1184864365
Registry record updated Jan 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
4750 Issued in OR
Legal business name
DIMOND PHYSICAL THERAPY AND PERFORMANCE LAB, LLC
Doing business as
The KOR
Practice address
735 SW 158TH Ave
Ste 160
Beaverton, OR 97006-4952
Phone
(503) 597-0035
Fax
(503) 296-2985
NPI assigned
Feb 27, 2009
Last updated
Jan 21, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Donnel T Dimond, PTNPI 1558303073
Title
Director/Owner
Phone
(503) 810-7264

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 4750 OR Primary

Addresses

Primary practice location

735 SW 158TH Ave
Ste 160
Beaverton, OR 97006-4952

Mailing address

735 SW 158TH Ave
Ste 160
Beaverton, OR 97006-4952
Phone (503) 597-0035

Other identifiers 1

IdentifierTypeStateIssuer
520244000OtherORREGENCE

Other names 1

  • The KOR Doing business as

National Provider Directory

National Provider Directory

Locations

735 SW 158th Ave
Ste 160
Beaverton, OR 97006
Phone (503) 597-0035

Practitioners & affiliated clinicians

Practitioners 40

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 40

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1235692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295568000000",
    "number": "1184864365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "735 SW 158TH AVE",
            "address_2": "STE 160",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970064952",
            "telephone_number": "503-597-0035",
            "fax_number": "503-296-2985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "735 SW 158TH AVE",
            "address_2": "STE 160",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970064952",
            "telephone_number": "503-597-0035",
            "fax_number": "503-296-2985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIMOND PHYSICAL THERAPY AND PERFORMANCE LAB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-27",
        "last_updated": "2011-01-21",
        "status": "A",
        "authorized_official_last_name": "DIMOND",
        "authorized_official_first_name": "DONNEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "DIRECTOR/OWNER",
        "authorized_official_telephone_number": "503-810-7264",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "4750",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "520244000",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The KOR",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Beaverton, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.