Individual
ANNA FORTUNATO PAYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1160 HOSPITAL RD STE 100, NEW ROADS, LA 70760-2633
(225) 638-4455
(225) 208-6173
Mailing address
12669 SHARP LN, PORT ALLEN, LA 70767-5427
(225) 939-1350
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A4574
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A4574
STATE LICENSE
LA
Enumeration date
05/06/2019
Last updated
05/06/2019
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