Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Justin Brent Dorn, DPT

Individual provider Physical Therapist · NPI 1245776327

Justin Brent Dorn, DPT is a Physical Therapist in Private Practice in South Lake Tahoe, California. Qualified in 2016, 10 years ago. Practices with PT Revolution Physical Therapy PC, a 12-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
10
Licensed in
CA
In the registry since
2017
What do these letters mean?
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.

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Practice location Address checks out

2038 Lake Tahoe Blvd
South Lake Tahoe, CA 96150-6499
Phone: (530) 208-9910
Fax: (530) 285-2001
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence PT292376 (CA)

Record details

NPI number1245776327
Entity typeIndividual (Type 1)
GenderMale
Credentials DPT
Sole proprietorNo
NPI enumeratedJanuary 12, 2017
Last updated in NPPESJanuary 20, 2021
Certification dateJanuary 20, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2016 (10 years in practice)
Group practice Pt Revolution Physical Therapy Pc — 12 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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