Provider Demographics
NPI:1619970514
Name:VAUGHAN, LYNN C (RPT)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:C
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 CENTER ST
Mailing Address - Street 2:STE 104
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-4243
Mailing Address - Country:US
Mailing Address - Phone:203-265-2500
Mailing Address - Fax:203-265-9222
Practice Address - Street 1:350 CENTER ST
Practice Address - Street 2:STE 104
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-4243
Practice Address - Country:US
Practice Address - Phone:203-265-2500
Practice Address - Fax:203-265-9222
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001746225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT650000621Medicare ID - Type Unspecified