Provider Demographics
NPI:1790522522
Name:VAUGHN, DALLAS LYNEE (PT, DPT)
Entity type:Individual
Prefix:MISS
First Name:DALLAS
Middle Name:LYNEE
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 ROSWELL RD NE APT 1025
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1417
Mailing Address - Country:US
Mailing Address - Phone:412-980-1137
Mailing Address - Fax:
Practice Address - Street 1:5881 GLENRIDGE DR STE 170
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5389
Practice Address - Country:US
Practice Address - Phone:404-236-0934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT017189225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist