Individual
MISS DEMITA G PAYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
10320 MALLARD CREEK RD, SUITE 275, CHARLOTTE, NC 28262-9756
(704) 549-9322
(704) 549-9460
Mailing address
10320 MALLARD CREEK RD, SUITE 275, CHARLOTTE, NC 28262-9756
(704) 549-9322
(704) 549-9460
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
9703
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7211595
—
NC
Enumeration date
05/31/2006
Last updated
07/08/2007
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