Provider Demographics
NPI:1790234185
Name:PAYNE, BRETT SAIZAN
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:SAIZAN
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 1:3025 COAL MINE AVE
Mailing Address - Street 2:12E
Mailing Address - City:RIFLE
Mailing Address - State:CO
Mailing Address - Zip Code:81650-3923
Mailing Address - Country:US
Mailing Address - Phone:970-379-5161
Mailing Address - Fax:
Practice Address - Street 1:832 DONEGAN RD
Practice Address - Street 2:C
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-2778
Practice Address - Country:US
Practice Address - Phone:970-379-5161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO34534776Medicaid