Provider Demographics
NPI:1306815881
Name:VAUGHN, CHARLES CHRISTOPHER III (MPT)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:CHRISTOPHER
Last Name:VAUGHN
Suffix:III
Gender:M
Credentials:MPT
Other - Prefix:
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Mailing Address - Street 1:33900 HARPER AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-416-9100
Mailing Address - Fax:586-416-9103
Practice Address - Street 1:1693 N CANTON CENTER RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2948
Practice Address - Country:US
Practice Address - Phone:734-738-0000
Practice Address - Fax:734-738-0038
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5501012709225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist