Healthcare Provider Details

I. General information

NPI: 1811602113
Provider Name (Legal Business Name): DORIAN HEJNY LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2023
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 HIGHWAY 121
BEDFORD TX
76021-5011
US

IV. Provider business mailing address

3801 TRINITY HILLS LN
EULESS TX
76040-7258
US

V. Phone/Fax

Practice location:
  • Phone: 817-540-4477
  • Fax:
Mailing address:
  • Phone: 682-551-1755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT8716
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: