Provider Demographics
NPI:1437646213
Name:VAUGHAN, WELSH (LMT)
Entity Type:Individual
Prefix:
First Name:WELSH
Middle Name:
Last Name:VAUGHAN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:VAUGHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16013 79TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-8884
Mailing Address - Country:US
Mailing Address - Phone:425-330-6613
Mailing Address - Fax:
Practice Address - Street 1:3131 SMOKEY POINT DRIVE
Practice Address - Street 2:#5B
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223
Practice Address - Country:US
Practice Address - Phone:425-330-6613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist