Provider Demographics
NPI:1659561041
Name:PAYNE, SYLVIA ROSE (DPT)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:ROSE
Last Name:PAYNE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SYLVIA
Other - Middle Name:ROSE
Other - Last Name:SISTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:101 S STATE ST STE 200G
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-3900
Mailing Address - Country:US
Mailing Address - Phone:503-636-3028
Mailing Address - Fax:503-636-1837
Practice Address - Street 1:101 S STATE ST STE 200G
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3900
Practice Address - Country:US
Practice Address - Phone:503-636-3028
Practice Address - Fax:503-636-1837
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5425225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist