Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 10450 | TN |
Y | 225100000X | Physical Therapist | PT014546 | GA |
NPI | 1003297037 |
---|---|
Provider Name | Laura Vaughn |
First Address | Chattanooga, TN 37421-4915 |
Second Address | Fort Oglethorpe, GA 30742-4010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2015 |
Last Update Date | 11/06/2020 |