Provider Demographics
NPI:1548421548
Name:VAUGHAN, HARRISON NEAL (PT)
Entity Type:Individual
Prefix:DR
First Name:HARRISON
Middle Name:NEAL
Last Name:VAUGHAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-0217
Mailing Address - Country:US
Mailing Address - Phone:434-447-3322
Mailing Address - Fax:434-447-3282
Practice Address - Street 1:1187 N MECKLENBURG AVE
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:VA
Practice Address - Zip Code:23950-1768
Practice Address - Country:US
Practice Address - Phone:434-447-3322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205478225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00702769OtherRAILROAD MEDICARE PTAN
VAP00702769OtherRAILROAD MEDICARE PTAN