Provider Demographics
NPI:1609213511
Name:PAYNE, JOSHUA ROSS
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ROSS
Last Name:PAYNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 W OAK ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-4325
Mailing Address - Country:US
Mailing Address - Phone:940-320-6030
Mailing Address - Fax:940-320-6030
Practice Address - Street 1:2445 W OAK ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4325
Practice Address - Country:US
Practice Address - Phone:940-320-6030
Practice Address - Fax:940-320-6030
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3113566225100000X
TX1232576225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist