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Individual

JOHN L. PAYNE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PT

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
002770
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
004082202
CT
01
08-0002770CT01
ANTHEM BC/BS
CT
01
508878
AETNA
CT
01
CD8409
RR MEDICARE
CT
Enumeration date
05/01/2006
Last updated
11/08/2012
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