Provider Demographics
NPI:1174528731
Name:VAUGHT, TRACY (PT)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:
Last Name:VAUGHT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2841 HARTLAND RD STE 401B
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-3500
Mailing Address - Country:US
Mailing Address - Phone:703-205-1233
Mailing Address - Fax:703-641-0189
Practice Address - Street 1:2841 HARTLAND RD STE 401B
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-3500
Practice Address - Country:US
Practice Address - Phone:703-205-1233
Practice Address - Fax:703-641-0189
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17970225100000X
VA002995225100000X
DC2212225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD387695ZBL8Medicare PIN