MEDICARE: LYNN C VAUGHAN RPT

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	001746	CT

General Provider Information

NPI Number	:	1619970514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN C VAUGHAN RPT

Provider Business Mailing Address
First Line	:	350 CENTER ST
Second Line	:	STE 104
City	:	WALLINGFORD
State	:	CT
Zip	:	06492-4243
Country	:	US
Telephone Number	:	203-265-2500
Fax Number	:	203-265-9222

Provider Business Practice Location Address
First Line	:	350 CENTER ST
Second Line	:	STE 104
City	:	WALLINGFORD
State	:	CT
Zip	:	06492-4243
Country	:	US
Telephone Number	:	203-265-2500
Fax Number	:	203-265-9222

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	10/12/2010

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