Provider Demographics
NPI:1184888943
Name:PAYNE, KELLY ANN (PT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:PAYNE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 COMMERCE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-7059
Mailing Address - Country:US
Mailing Address - Phone:910-477-6236
Mailing Address - Fax:910-477-6357
Practice Address - Street 1:292 COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-7059
Practice Address - Country:US
Practice Address - Phone:910-477-6236
Practice Address - Fax:910-477-6357
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11317225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP11317OtherPT LICENSE