Provider Demographics
NPI:1295936235
Name:PAYNE, BLYTHE LUCILLE (LMT)
Entity type:Individual
Prefix:MRS
First Name:BLYTHE
Middle Name:LUCILLE
Last Name:PAYNE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 809
Mailing Address - Street 2:
Mailing Address - City:QUOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11959-0809
Mailing Address - Country:US
Mailing Address - Phone:631-653-8295
Mailing Address - Fax:631-653-8295
Practice Address - Street 1:132 MAIN ST UNIT 2
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON BEACH
Practice Address - State:NY
Practice Address - Zip Code:11978-2627
Practice Address - Country:US
Practice Address - Phone:631-875-6186
Practice Address - Fax:631-653-8295
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014989-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist