Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 8683 | AZ |
NPI | 1003108762 |
---|---|
Provider Name | Anda Michelle Vaughn |
First Address | Mesa, AZ 85207-1917 |
Second Address | Mesa, AZ 85206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2011 |
Last Update Date | 12/05/2011 |