MEDICARE: MISS DALLAS LYNEE VAUGHN PT, DPT

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	225100000X	Physical Therapist	PT44059	FL
2	225100000X	Physical Therapist	PT017189	GA

General Provider Information

NPI Number	:	1790522522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DALLAS LYNEE VAUGHN PT, DPT

Provider Business Mailing Address
First Line	:	PO BOX 632653
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-2653
Country	:	US
Telephone Number	:	941-870-0110
Fax Number	:

Provider Business Practice Location Address
First Line	:	10676 COLONIAL BLVD STE 50
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33913-8715
Country	:	US
Telephone Number	:	941-870-0110
Fax Number	:	239-465-4504

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

Provider Enumeration Date	:	07/10/2024
Last Update Date	:	12/11/2025

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