Provider Demographics
NPI:1821465774
Name:VAUGHAN, DANIELLE (DPT)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 HIGHWAY 81 SOUTH
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-3918
Mailing Address - Country:US
Mailing Address - Phone:770-554-0665
Mailing Address - Fax:770-554-0685
Practice Address - Street 1:1520 SUNDAY DR
Practice Address - Street 2:SUITE 105
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-5253
Practice Address - Country:US
Practice Address - Phone:919-420-1682
Practice Address - Fax:919-719-3531
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP13803225100000X
NC2305206453225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist