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NPI Code Detail

MEDICARE: ELISSA MARIE PAYONK DPT

MEDICARE: ELISSA MARIE PAYONK DPT
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
1225100000XPhysical Therapist0017791CO
2225100000XPhysical Therapist007776KY

General Provider Information

NPI Number : 1225686744
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELISSA MARIE PAYONK DPT
Provider Business Mailing Address
First Line : 815 TRIPLETT ST
Second Line :
City : OWENSBORO
State : KY
Zip : 42303-3564
Country : US
Telephone Number : 270-683-4517
Fax Number : 270-852-1491
Provider Business Practice Location Address
First Line : 901 N SANTA FE AVE
Second Line :
City : FOUNTAIN
State : CO
Zip : 80817-1738
Country : US
Telephone Number : 719-597-0822
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2019
Last Update Date : 01/04/2023

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