Provider Demographics
NPI:1962465344
Name:VAUGHN POWELL, JONI D (RPT)
Entity Type:Individual
Prefix:MRS
First Name:JONI
Middle Name:D
Last Name:VAUGHN POWELL
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 1:1951 BENCH RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-2073
Mailing Address - Country:US
Mailing Address - Phone:208-237-2080
Mailing Address - Fax:208-237-1084
Practice Address - Street 1:1951 BENCH RD
Practice Address - Street 2:SUITE E
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2073
Practice Address - Country:US
Practice Address - Phone:208-237-2080
Practice Address - Fax:208-237-1084
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRPT - 763225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDT4678OtherNDPT BLUE CROSS OF ID
ID000010025951OtherNDPT REGENCE OF ID
ID1652929Medicare ID - Type UnspecifiedHIGHLAND PT
ID1652928Medicare ID - Type UnspecifiedNEW DAY PHYSICAL THERAPY