MEDICARE: ABIGAIL VAUGHN CARRANZA

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
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1558210286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL VAUGHN CARRANZA

Provider Business Mailing Address
First Line	:	2122 YORK RD STE 300
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1925
Country	:	US
Telephone Number	:	630-575-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	6366 N COSBY AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64151-2344
Country	:	US
Telephone Number	:	816-683-8618
Fax Number	:	816-683-2318

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2026
Last Update Date	:	01/26/2026

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