Provider Demographics
NPI:1760560700
Name:PAYNE, JOHN W (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:W
Last Name:PAYNE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1392 W 6500 S
Mailing Address - Street 2:
Mailing Address - City:HYRUM
Mailing Address - State:UT
Mailing Address - Zip Code:84319-7105
Mailing Address - Country:US
Mailing Address - Phone:801-863-0654
Mailing Address - Fax:
Practice Address - Street 1:169 N GATEWAY DR STE 210
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-9805
Practice Address - Country:US
Practice Address - Phone:435-701-7010
Practice Address - Fax:435-701-7012
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT9170225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB40203Medicare PIN