Justin Brent Dorn, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT292376 Issued in CA

Practice address

2038 Lake Tahoe Blvd
South Lake Tahoe, CA 96150-6499

Phone

(530) 208-9910

Fax

(530) 285-2001

NPI assigned

Jan 12, 2017

Last updated

Jan 20, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

PT Revolution Physical Therapy PCGroup PAC ID 5092174987, 12 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• PT Revolution Physical Therapy, PC

  • Physical Therapy Clinic/Center
  • South Lake Tahoe, CA
  • NPI 1467179663

  Physical Therapist

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1484179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611100800000",
    "number": "1245776327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2038 LAKE TAHOE BLVD",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961506499",
            "telephone_number": "530-208-9910",
            "fax_number": "530-285-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2038 LAKE TAHOE BLVD",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961506499",
            "telephone_number": "530-208-9910",
            "fax_number": "530-285-2001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DORN",
        "first_name": "JUSTIN",
        "middle_name": "BRENT",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-01-12",
        "last_updated": "2021-01-20",
        "certification_date": "2021-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT292376",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mandi Dickie
• Peter Digrande
• Julia Deborah Dirnu
• Leeroy Dixon
• Casey Donahue
• Douglas W. Mundy (Tahoe Valley Pharmacy)
• William Arthur Downey, OD
• Michael Phillip Doyle, MEDICAL DOCTOR
• Elizabeth Drabant
• Cheryl Drake, L.AC.

• Physical Therapist in South Lake Tahoe, CA
• Providers in South Lake Tahoe, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.