Vaughan Gendelman, DPT
Individual provider Active NPI Physical Therapist · Ilwaco, WA
NPI 1407404155 · NPPES record last updated Aug 27, 2019
Key facts
- NPI
- 1407404155
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT60992382 (WA)
- Practice address
- 174 1St Ave N
Ilwaco, WA 98624-9137 - Phone
- (360) 642-6328
- NPI assigned
- Aug 27, 2019
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT60992382 | WA | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT60992382 | WA | Yes |
Addresses
Primary practice location
174 1St Ave N
Ilwaco, WA 98624-9137
Mailing address
1487 SE Snowberry LN Apt 410
Warrenton, OR 97146-6605
Other providers in Ilwaco, WA
- Brent Lawrence Corvalan
- Discovery Coast Emergency Physicians LLC
- Edouard J Duret
- Albert O Fabiano
- Susan C Freese
- Jeffrey Shane Harrell
- Brenda Simone Haskett
- Cyrus Dale Haskett Jr.
- Anya Marie Milrod Holmquist
- Chase Honer
All providers in Ilwaco, WA · Physical Therapist in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 27, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.