MEDICARE: CODY ROBERT PAYNE P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	4021	OK
2	225100000X	Physical Therapist	1197631	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4021	OTHER	OK	STATE LICENSE

General Provider Information

NPI Number	:	1053501437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CODY ROBERT PAYNE P.T.

Provider Business Mailing Address
First Line	:	3613 NW 56TH ST
Second Line	:	SUITE 202
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4526
Country	:	US
Telephone Number	:	405-948-8686
Fax Number	:	405-978-8603

Provider Business Practice Location Address
First Line	:	3613 NW 56TH ST
Second Line	:	SUITE 202
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4526
Country	:	US
Telephone Number	:	405-948-8686
Fax Number	:	405-978-8603

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2007
Last Update Date	:	10/27/2014

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Directions to “ CODY ROBERT PAYNE P.T.” Practice Location

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