Healthcare Provider Details

I. General information

NPI: 1558137729
Provider Name (Legal Business Name): LYNNE MARIE PAYNE-RICHARDSON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2023
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 KARL DR
ALEXANDRIA MN
56308-5264
US

IV. Provider business mailing address

111 17TH AVE E
ALEXANDRIA MN
56308-5273
US

V. Phone/Fax

Practice location:
  • Phone: 320-762-6479
  • Fax: 320-759-6562
Mailing address:
  • Phone: 320-762-6079
  • Fax: 320-762-6123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number3062
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: