Healthcare Provider Details

I. General information

NPI: 1902723521
Provider Name (Legal Business Name): KALIEGH PAYNE LAUREL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1567 MAIN ST
CHIPLEY FL
32428-6948
US

IV. Provider business mailing address

1567 MAIN ST
CHIPLEY FL
32428-6948
US

V. Phone/Fax

Practice location:
  • Phone: 850-638-3387
  • Fax: 866-630-5149
Mailing address:
  • Phone: 850-638-3387
  • Fax: 866-630-5149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTT44834
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: