Individual
MARY JANE VAUGHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
3160 8TH ST SW, SUITE 1, ALTOONA, IA 50009-1023
(515) 967-4580
(515) 967-4899
Mailing address
205 W WACKER DRIVE, SUITE 1020, CHICAGO, IL 60606-1216
(312) 640-0329
(312) 640-0407
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
01243
IA
225100000X
Physical Therapist
Primary
070-001801
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070-001801
PT STATE LICENSE #
IL
Enumeration date
01/09/2007
Last updated
10/17/2012
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