MEDICARE: AVRY RUTLEDGE PAYNE MPT

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	P11237	NC

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

General Provider Information

NPI Number	:	1528144888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVRY RUTLEDGE PAYNE MPT

Provider Business Mailing Address
First Line	:	4201 LAKE BOONE TRAIL
Second Line	:	SUITE 4
City	:	RALEIGH
State	:	NC
Zip	:	27607-7511
Country	:	US
Telephone Number	:	919-781-4434
Fax Number	:	919-781-5851

Provider Business Practice Location Address
First Line	:	4201 LAKE BOONE TRAIL
Second Line	:	SUITE 4
City	:	RALEIGH
State	:	NC
Zip	:	27607-7511
Country	:	US
Telephone Number	:	919-781-4434
Fax Number	:	919-781-5851

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

Provider Enumeration Date	:	10/30/2006
Last Update Date	:	01/13/2026

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