Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 1684 | TX |
NPI | 1720170608 |
---|---|
Provider Name | Ms. Teia D. Vaughn |
First Address | Augusta, GA 30904 |
Second Address | Evans, GA 30809-5285 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 08/07/2007 |