MEDICARE: MS. LEAH KATHLEEN-JORDAN DORN ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	2000023970	CA

General Provider Information

NPI Number	:	1508392127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LEAH KATHLEEN-JORDAN DORN ATC

Provider Business Mailing Address
First Line	:	6712 SOMERSWORTH DR
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95621-4124
Country	:	US
Telephone Number	:	916-992-4853
Fax Number	:

Provider Business Practice Location Address
First Line	:	6712 SOMERSWORTH DR
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95621-4124
Country	:	US
Telephone Number	:	916-992-4853
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2017
Last Update Date	:	07/12/2023

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