Provider Demographics
NPI:1346552452
Name:VAUGHN, ANNA MARIE (MPT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12529 LEATHERLEAF DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-3045
Mailing Address - Country:US
Mailing Address - Phone:336-601-4726
Mailing Address - Fax:
Practice Address - Street 1:206 RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4617
Practice Address - Country:US
Practice Address - Phone:813-662-1060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25517225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist