Provider Demographics
NPI:1700199775
Name:PAYNE, ASHLEY (PT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 S GILBERT RD STE 115
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-1608
Mailing Address - Country:US
Mailing Address - Phone:480-632-6667
Mailing Address - Fax:480-632-6668
Practice Address - Street 1:323 S GILBERT RD STE 115
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-1608
Practice Address - Country:US
Practice Address - Phone:480-632-6667
Practice Address - Fax:480-632-6668
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8940208100000X, 2081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine