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NPI Code Detail

MEDICARE: DR. MICHAEL BRENDAN VAUGHN PT, DPT

MEDICARE: DR. MICHAEL BRENDAN 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
1225100000XPhysical Therapist26521MD
2225100000XPhysical TherapistP23016NC

General Provider Information

NPI Number : 1942723267
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL BRENDAN VAUGHN PT, DPT
Provider Business Mailing Address
First Line : 1 MEDICAL CENTER BLVD
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27107-0001
Country : US
Telephone Number : 336-716-2255
Fax Number : 336-716-3202
Provider Business Practice Location Address
First Line : 1901 MOONEY ST
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27103-3027
Country : US
Telephone Number : 336-716-8091
Fax Number : 336-716-9253
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2017
Last Update Date : 08/29/2024

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