Provider Demographics
NPI:1134633167
Name:PAYNE, PATRICIA (NYS LMT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:NYS LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 227
Mailing Address - Street 2:
Mailing Address - City:SOUTHOLD
Mailing Address - State:NY
Mailing Address - Zip Code:11971-0227
Mailing Address - Country:US
Mailing Address - Phone:631-766-3586
Mailing Address - Fax:
Practice Address - Street 1:53345 MAIN RD
Practice Address - Street 2:SUITE 6-1, 6-3
Practice Address - City:SOUTHOLD
Practice Address - State:NY
Practice Address - Zip Code:11971
Practice Address - Country:US
Practice Address - Phone:631-765-2100
Practice Address - Fax:631-765-2100
Is Sole Proprietor?:No
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009316225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist