Healthcare Provider Details

I. General information

NPI: 1154823029
Provider Name (Legal Business Name): TAYLOR PAYNE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 GADSDEN HWY STE 135
BIRMINGHAM AL
35235-3154
US

IV. Provider business mailing address

2823 GREYSTONE COMMERCIAL BLVD
HOOVER AL
35242-2660
US

V. Phone/Fax

Practice location:
  • Phone: 205-655-1921
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number1636
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH10354
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: