Healthcare Provider Details

I. General information

NPI: 1164342929
Provider Name (Legal Business Name): DEANNA VAUGHN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 ADA AVE STE 102
CONWAY AR
72034-4014
US

IV. Provider business mailing address

1435 CROSSPOINT RD
CONWAY AR
72034-8422
US

V. Phone/Fax

Practice location:
  • Phone: 501-513-5108
  • Fax:
Mailing address:
  • Phone: 501-260-0347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT4723
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: