Provider Demographics
NPI:1851676894
Name:PAYNE, ANTHONY
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
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 1:580 W CHEYENNE AVE STE 70
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-3978
Mailing Address - Country:US
Mailing Address - Phone:702-648-3913
Mailing Address - Fax:702-868-8357
Practice Address - Street 1:580 W CHEYENNE AVE
Practice Address - Street 2:STE 70
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-3967
Practice Address - Country:US
Practice Address - Phone:702-648-3913
Practice Address - Fax:702-868-8357
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner