Basic Information
| Provider Information | |||||||||
| NPI: | 1184276784 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VERNON | ||||||||
| FirstName: | AARON | ||||||||
| MiddleName: | BRENT | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 STARLITE DR UNIT B | ||||||||
| Address2: | |||||||||
| City: | CLOVIS | ||||||||
| State: | NM | ||||||||
| PostalCode: | 881014178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8016634073 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3128 BOXELDER DR | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820015808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076347901 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2019 | ||||||||
| LastUpdateDate: | 07/12/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT5407 | NM | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.