Healthcare Provider Details

I. General information

NPI: 1285059527
Provider Name (Legal Business Name): VAUGHN PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2014
Last Update Date: 03/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 LAUREL ST
COLUMBIA SC
29201-2626
US

IV. Provider business mailing address

1825 LAUREL ST
COLUMBIA SC
29201-2626
US

V. Phone/Fax

Practice location:
  • Phone: 803-351-9906
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number6367
License Number StateSC

VIII. Authorized Official

Name: BRANDON PHYSICAL VAUGHN
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 803-351-9906