Dna Physical Therapy and Athletic Club, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

06049 Issued in OR

Legal business name

DNA PHYSICAL THERAPY AND ATHLETIC CLUB, LLC

Practice address

12305 SW Horizon Blvd Ste 201
Beaverton, OR 97007-9500

Phone

(971) 708-6113

Fax

(971) 708-6988

NPI assigned

Aug 15, 2017

Organization subpart

No

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

Authorized official

Name

Andrea Patricia Bulat, PT

Title

Co-Owner

Phone

(503) 308-2814

Specialties & licenses 1

Addresses

Other names 1

• DNA Physical Therapy & Athletics Doing business as

Locations

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

{
    "created_epoch": "1502755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512000000000",
    "number": "1710403340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 NICHOLAS WAY",
            "city": "NEWBERG",
            "state": "OR",
            "postal_code": "971322354",
            "telephone_number": "503-423-7456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12305 SW HORIZON BLVD STE 201",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970079500",
            "telephone_number": "971-708-6113",
            "fax_number": "971-708-6988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DNA PHYSICAL THERAPY AND ATHLETIC CLUB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-15",
        "last_updated": "2017-11-30",
        "status": "A",
        "authorized_official_last_name": "BULAT",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_middle_name": "PATRICIA",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "503-308-2814",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "06049",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DNA Physical Therapy & Athletics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Divinecarellc
• Gary V. Dixon, D.D.S.
• Mario Dixon
• Danise Aubrey Dlouhy, DPT
• Oleksandr Dmytruk, RBT
• Diem-Chau H DO, RPH
• Julie Dee DO, RDH
• Lewis DO
• Phillip Phi DO, PHARMD
• Tina DO

• Physical Therapist in Beaverton, OR
• Providers in Beaverton, OR by specialty
• Physical Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2017; 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.