Individual
MR. BRADLEY ALLEN VAUGHN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1600 RIVERFRONT DR, LITTLE ROCK, AR 72202
(501) 663-6965
Mailing address
1600 RIVERFRONT DR., LITTLE ROCK, AR 72202
(501) 663-6965
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA2054
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTA2054
PTA LICENSE
AR
Enumeration date
09/16/2006
Last updated
09/28/2010
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