Healthcare Provider Details

I. General information

NPI: 1083307169
Provider Name (Legal Business Name): PAYTON JAMES ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20342 86TH PL NE
BOTHELL WA
98011-2270
US

IV. Provider business mailing address

20342 86TH PL NE
BOTHELL WA
98011-2270
US

V. Phone/Fax

Practice location:
  • Phone: 425-985-9539
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: