Provider Demographics
NPI:1396498838
Name:VAUGHN THERAPY GROUP LLC
Entity type:Organization
Organization Name:VAUGHN THERAPY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:S
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, CLT
Authorized Official - Phone:571-245-0205
Mailing Address - Street 1:14748 WINTERFIELD CT
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-2977
Mailing Address - Country:US
Mailing Address - Phone:571-245-0205
Mailing Address - Fax:
Practice Address - Street 1:14748 WINTERFIELD CT
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-2977
Practice Address - Country:US
Practice Address - Phone:571-245-0205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty