Healthcare Provider Details

I. General information

NPI: 1306948625
Provider Name (Legal Business Name): JENNIFER PAYNE MCCARTNEY PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER JE PAYNE PT

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9154 ESTATE THOMAS
ST THOMAS VI
00802-2687
US

IV. Provider business mailing address

9154 ESTATE THOMAS
ST THOMAS VI
00802-2687
US

V. Phone/Fax

Practice location:
  • Phone: 340-776-7667
  • Fax: 340-714-1891
Mailing address:
  • Phone: 340-776-7667
  • Fax: 340-714-1891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number62027738
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number17664
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number145
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: