Provider Demographics
NPI:1528390630
Name:PAYTON, WAYNE ALTON I (LMT, MMP)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:ALTON
Last Name:PAYTON
Suffix:I
Gender:M
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 SHILOH RD
Mailing Address - Street 2:APT 4021
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-8257
Mailing Address - Country:US
Mailing Address - Phone:214-718-4177
Mailing Address - Fax:972-780-9992
Practice Address - Street 1:1414 SHILOH RD
Practice Address - Street 2:APT 4021
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-8257
Practice Address - Country:US
Practice Address - Phone:214-718-4177
Practice Address - Fax:972-780-9992
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT039221172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist