Provider Demographics
NPI:1225532013
Name:VAUGHT, AMY JEAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JEAN
Last Name:VAUGHT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:JEAN
Other - Last Name:CORBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:154 KINTER WAY STE A
Mailing Address - Street 2:
Mailing Address - City:PEARISBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24134-2218
Mailing Address - Country:US
Mailing Address - Phone:540-921-5200
Mailing Address - Fax:540-921-5100
Practice Address - Street 1:154 KINTER WAY STE A
Practice Address - Street 2:
Practice Address - City:PEARISBURG
Practice Address - State:VA
Practice Address - Zip Code:24134-2218
Practice Address - Country:US
Practice Address - Phone:540-921-5200
Practice Address - Fax:540-921-5100
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305210990225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist