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NPI Code Detail

MEDICARE: BROOKE VAUGHN DPT

MEDICARE: BROOKE VAUGHN DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12251S0007XSports Physical Therapist
22251X0800XOrthopedic Physical Therapist
3225100000XPhysical Therapist11745AZ

General Provider Information

NPI Number : 1548636533
Entity Type Code : Individual
Provider Name (Legal Business Name) : BROOKE VAUGHN DPT
Provider Business Mailing Address
First Line : 15410 S MOUNTAIN PKWY
Second Line : SUITE 112
City : PHOENIX
State : AZ
Zip : 85044-6691
Country : US
Telephone Number : 480-706-1161
Fax Number : 480-706-7997
Provider Business Practice Location Address
First Line : 2122 E HIGHLAND AVE STE 200
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-4777
Country : US
Telephone Number : 602-778-0900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2015
Last Update Date : 09/24/2024

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Directions to “ BROOKE VAUGHN DPT” Practice Location

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