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General NPI Number Information
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NPI Number | 1417395120
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Entity Type | Individual
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Provider Name | JASON DORN MPT
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Gender | Male
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Dates
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Enumeration Date | 06/05/2013
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 3916 CHELSEA DR
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City | LA VERNE
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State | CA
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Zip | 91750-2608
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Country | US
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Telephone | 949-748-7892
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Fax | 949-215-4281
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Provider Business Mailing Address
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Address Line | 3916 CHELSEA DR.
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City | LA VERNE
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State | CA
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Zip | 91750
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Country | US
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Telephone | 949-748-7892
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT28695
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2251E1200X
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Taxonomy Name | Ergonomics Physical Therapist
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License Number | PT28695
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | PT28695
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT28695
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License Number State | CA
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