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General NPI Number Information
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NPI Number | 1902612401
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Entity Type | Individual
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Provider Name | BREANNA VAUGHN PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 12/09/2024
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 801 N STATE ST
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City | GREENFIELD
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State | IN
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Zip | 46140-1270
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Country | US
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Telephone | 317-462-5544
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Fax |
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Provider Business Mailing Address
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Address Line | 105 W FALCON RUN
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City | PENDLETON
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State | IN
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Zip | 46064-9141
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Country | US
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Telephone | 765-635-1138
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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