Individual
DANIEL VAUGHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
4100 LAKE DR SE, SUITE 305, GRAND RAPIDS, MI 49546-8292
(616) 285-1377
(616) 285-1006
Mailing address
61 COMMERCE AVE SW, GRAND RAPIDS, MI 49503-4124
(616) 940-0660
(616) 940-1965
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501004499
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
650D113810
BCBSM
MI
Enumeration date
01/03/2007
Last updated
11/19/2008
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