Healthcare Provider Details

I. General information

NPI: 1255416699
Provider Name (Legal Business Name): RONALD PAYNE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 GOSS AVE
LOUISVILLE KY
40217-1239
US

IV. Provider business mailing address

1227 GOSS AVE.
LOUISVILLE KY
40217-1239
US

V. Phone/Fax

Practice location:
  • Phone: 502-636-1200
  • Fax:
Mailing address:
  • Phone: 502-636-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: