Healthcare Provider Details

I. General information

NPI: 1033537600
Provider Name (Legal Business Name): JOSHUA DOUGLAS VAUGHAN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 8TH DIVISION RD
COLUMBIA SC
29207-5700
US

IV. Provider business mailing address

4500 8TH DIVISION RD
COLUMBIA SC
29207-5700
US

V. Phone/Fax

Practice location:
  • Phone: 803-751-2160
  • Fax: 803-751-2321
Mailing address:
  • Phone: 803-751-2160
  • Fax: 803-751-2321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number8672
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: