Provider Demographics
NPI:1043338528
Name:PAYNE, LORENA PETTET (PT)
Entity Type:Individual
Prefix:
First Name:LORENA
Middle Name:PETTET
Last Name:PAYNE
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 1:7010 CAMP CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:MT
Mailing Address - Zip Code:59741-8343
Mailing Address - Country:US
Mailing Address - Phone:406-581-3147
Mailing Address - Fax:
Practice Address - Street 1:7010 CAMP CREEK RD
Practice Address - Street 2:REHAB
Practice Address - City:MANHATTAN
Practice Address - State:MT
Practice Address - Zip Code:59741-8343
Practice Address - Country:US
Practice Address - Phone:406-581-3147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1636PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0347956Medicaid
MT0347956Medicaid