Provider Demographics
NPI:1477371904
Name:PAYNE, JAELYNN
Entity type:Individual
Prefix:
First Name:JAELYNN
Middle Name:
Last Name:PAYNE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7222 SOUTH PEEK RD APT 3214
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407
Mailing Address - Country:US
Mailing Address - Phone:505-917-5150
Mailing Address - Fax:
Practice Address - Street 1:23225 KINGSLAND BLVD STE 600
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-3705
Practice Address - Country:US
Practice Address - Phone:281-395-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1391686225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist