Provider Demographics
NPI:1871610618
Name:VAUGHN, KEITH A (PT)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:A
Last Name:VAUGHN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 CORALWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-2709
Mailing Address - Country:US
Mailing Address - Phone:423-239-4366
Mailing Address - Fax:423-224-5776
Practice Address - Street 1:401 SCENIC DR
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37857-2452
Practice Address - Country:US
Practice Address - Phone:423-921-7224
Practice Address - Fax:423-921-7227
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000003655225100000X
VA0105006341225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist