Individual
ELLEN K. PAYNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, ATC, CSCS
Contact information
Practice address
302 PORTOLA RD, PORTOLA VALLEY, CA 94028-7851
(650) 851-6128
Mailing address
PO BOX 247, CUPERTINO, CA 95015-0247
(408) 348-7448
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
07/16/2006
Last updated
07/08/2007
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