Provider Demographics
NPI:1558720987
Name:DORN, PAUL (PTA)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:DORN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73650 345TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:MN
Mailing Address - Zip Code:56081-5555
Mailing Address - Country:US
Mailing Address - Phone:507-351-7615
Mailing Address - Fax:
Practice Address - Street 1:73650 345TH ST
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:MN
Practice Address - Zip Code:56081-5555
Practice Address - Country:US
Practice Address - Phone:507-351-7615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor