Provider Demographics
NPI:1306815881
Name:VAUGHN, CHARLES CHRISTOPHER III (MPT)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:CHRISTOPHER
Last Name:VAUGHN
Suffix:III
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 PAULINE BLVD STE 80
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-5003
Mailing Address - Country:US
Mailing Address - Phone:734-263-8405
Mailing Address - Fax:
Practice Address - Street 1:1955 PAULINE BLVD STE 80
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-5003
Practice Address - Country:US
Practice Address - Phone:734-263-8405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012709225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist