Provider Demographics
NPI:1508405671
Name:PAYNE, JAMES ALLEN (PTA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ALLEN
Last Name:PAYNE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 BLYTHE AVE
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-4412
Mailing Address - Country:US
Mailing Address - Phone:610-322-7756
Mailing Address - Fax:
Practice Address - Street 1:15 RIDGECREST CIR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-6367
Practice Address - Country:US
Practice Address - Phone:570-522-6234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE012364225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant