Provider Demographics
NPI:1356822472
Name:KING-PAYNE, KAREN (MPT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:KING-PAYNE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 NW 126TH AVE # 1-320
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-6320
Mailing Address - Country:US
Mailing Address - Phone:954-651-2499
Mailing Address - Fax:
Practice Address - Street 1:6931 W SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33313-4406
Practice Address - Country:US
Practice Address - Phone:954-583-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT17928225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist