Healthcare Provider Details

I. General information

NPI: 1316031248
Provider Name (Legal Business Name): PATRICIA P VAUGHAN P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 WATER ST W APT 445
SAINT PAUL MN
55107-2061
US

IV. Provider business mailing address

150 WATER ST W APT 445
SAINT PAUL MN
55107-2061
US

V. Phone/Fax

Practice location:
  • Phone: 936-661-6046
  • Fax:
Mailing address:
  • Phone: 936-661-6046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1028009
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: