Provider Demographics
NPI:1760770309
Name:PAYNE, CASEY R (DPT)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:R
Last Name:PAYNE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:R
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23505 SMITHTOWN RD
Mailing Address - Street 2:STE 100
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-4542
Mailing Address - Country:US
Mailing Address - Phone:763-220-6064
Mailing Address - Fax:763-260-7653
Practice Address - Street 1:11995 SINGLETREE LN STE 120
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-5338
Practice Address - Country:US
Practice Address - Phone:952-373-5720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8779225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist