Provider Demographics
NPI:1952688145
Name:PAYNE, MELISSA DAWN (LMT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:DAWN
Last Name:PAYNE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7349 BURLINGTON PIKE
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1509
Mailing Address - Country:US
Mailing Address - Phone:859-525-7443
Mailing Address - Fax:859-525-0750
Practice Address - Street 1:7349 BURLINGTON PIKE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1509
Practice Address - Country:US
Practice Address - Phone:859-525-7443
Practice Address - Fax:859-525-0750
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4026225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist