Provider Demographics
NPI:1336128743
Name:PAYNE, CHRISTOPHER M (MPT)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:M
Last Name:PAYNE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PEACH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1423
Mailing Address - Country:US
Mailing Address - Phone:814-877-6195
Mailing Address - Fax:814-877-5067
Practice Address - Street 1:100 PEACH ST STE 101
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1423
Practice Address - Country:US
Practice Address - Phone:814-877-6195
Practice Address - Fax:814-877-5067
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016170225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA067905JNGMedicare ID - Type UnspecifiedPHYSICAL THERAPY