Basic Information
Provider Information
NPI: 1003297037
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VAUGHN
FirstName: LAURA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PT, MPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6397 LEE HWY STE 300
Address2:  
City: CHATTANOOGA
State: TN
PostalCode: 374214915
CountryCode: US
TelephoneNumber: 4232387217
FaxNumber: 4232383473
Practice Location
Address1: 1394 BATTLEFIELD PKWY
Address2:  
City: FORT OGLETHORPE
State: GA
PostalCode: 307424010
CountryCode: US
TelephoneNumber: 7068580252
FaxNumber: 7068580323
Other Information
ProviderEnumerationDate: 06/16/2015
LastUpdateDate: 06/11/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/11/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X10450TNN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 
225100000XPT014546GAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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