Provider Demographics
NPI:1013311372
Name:VAUGHAN, BRITTANY (PTA)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 AVENIDA DE MEXICO
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-7169
Mailing Address - Country:US
Mailing Address - Phone:432-559-1740
Mailing Address - Fax:
Practice Address - Street 1:1129 AVENIDA DE MEXICO
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-7169
Practice Address - Country:US
Practice Address - Phone:432-559-1740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2093523225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant