Provider Demographics
NPI:1447329834
Name:VAUGHN, KEVIN (DPT)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:VAUGHN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 MANGROVE AVE
Mailing Address - Street 2:SUITE B224
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3509
Mailing Address - Country:US
Mailing Address - Phone:530-892-2966
Mailing Address - Fax:530-892-2929
Practice Address - Street 1:1044 MANGROVE AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3509
Practice Address - Country:US
Practice Address - Phone:530-892-2966
Practice Address - Fax:530-892-2929
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 21705225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT0217050OtherMEDI-CAL NUMBER
CA0PT217050Medicare PIN
CAWPT21705AMedicare PIN