Provider Demographics
NPI:1053760645
Name:VAUGHN, ULANDY MARIE (PTA)
Entity type:Individual
Prefix:
First Name:ULANDY
Middle Name:MARIE
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 FALLSTAFF RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-8068
Mailing Address - Country:US
Mailing Address - Phone:803-464-6346
Mailing Address - Fax:866-380-8786
Practice Address - Street 1:105 FALLSTAFF RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-8068
Practice Address - Country:US
Practice Address - Phone:803-464-6346
Practice Address - Fax:866-380-8786
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1705225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant