Provider Demographics
NPI:1275368821
Name:VAUGHN, BRANDON (PT)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
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 1:4440 N SONOMA RANCH BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-7336
Mailing Address - Country:US
Mailing Address - Phone:575-222-0188
Mailing Address - Fax:575-652-4142
Practice Address - Street 1:4440 N SONOMA RANCH BLVD STE B
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-7336
Practice Address - Country:US
Practice Address - Phone:575-222-0188
Practice Address - Fax:575-652-4142
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPT-2024-0204225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist