Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2093523 | TX |
NPI | 1013311372 |
---|---|
Provider Name | Brittany Vaughan |
First Address | Odessa, TX 79761-7169 |
Second Address | Odessa, TX 79761-7169 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2014 |
Last Update Date | 15/10/2014 |