Provider Demographics
NPI:1932755766
Name:VAUGHN, JONATHAN COLE (DPT)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:COLE
Last Name:VAUGHN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1350 S GUTENSOHN RD STE 10
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-5210
Mailing Address - Country:US
Mailing Address - Phone:479-751-7122
Mailing Address - Fax:479-751-7292
Practice Address - Street 1:2793 E MILLENNIUM PL STE 2
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-6522
Practice Address - Country:US
Practice Address - Phone:479-521-2232
Practice Address - Fax:479-521-0513
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT4686225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist