Provider Demographics
NPI:1518622331
Name:VAUGHN, SABRINA (LMT)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3508 MARKET ST UNIT 3973
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77522-5131
Mailing Address - Country:US
Mailing Address - Phone:832-378-8360
Mailing Address - Fax:
Practice Address - Street 1:2306 SANDERS BROOK DR
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-7642
Practice Address - Country:US
Practice Address - Phone:832-378-8360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT134320225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty