Athletic Advantage Physical Therapy LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

ATHLETIC ADVANTAGE PHYSICAL THERAPY LLC

Practice address

2412 E O Ave
La Grande, OR 97850-3853

Phone

(541) 519-0822

NPI assigned

Jun 17, 2024

Last updated

Jun 17, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Rachael Dillavou, PT, DPTNPI 1588192611

Title

Owner, Physical Therapist

Phone

(541) 519-0822

Specialties & licenses 1

Addresses

Practitioners 1

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.

• Rachael Dillavou, PT, DPT

  • Physical Therapist
  • La Grande, OR
  • NPI 1588192611
  NPD Authorized official

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

{
    "created_epoch": "1718582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718582400000",
    "number": "1922841196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2412 E O AVE",
            "city": "LA GRANDE",
            "state": "OR",
            "postal_code": "978503853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2412 E O AVE",
            "city": "LA GRANDE",
            "state": "OR",
            "postal_code": "978503853",
            "telephone_number": "541-519-0822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATHLETIC ADVANTAGE PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-17",
        "last_updated": "2024-06-17",
        "certification_date": "2024-06-16",
        "status": "A",
        "authorized_official_last_name": "DILLAVOU",
        "authorized_official_first_name": "RACHAEL",
        "authorized_official_title_or_position": "OWNER, PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "541-519-0822",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in La Grande, OR
• Providers in La Grande, OR by specialty
• Physical Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2024; 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.