Provider Demographics
NPI:1831548734
Name:VAUGHT, SHAWN (LMT)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:VAUGHT
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 HEBRON PARK DR
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:KY
Mailing Address - Zip Code:41048-8510
Mailing Address - Country:US
Mailing Address - Phone:859-586-9777
Mailing Address - Fax:
Practice Address - Street 1:2950 HEBRON PARK DR
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:KY
Practice Address - Zip Code:41048-8510
Practice Address - Country:US
Practice Address - Phone:859-586-9777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY163190225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist