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General NPI Number Information
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NPI Number | 1700531050
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Entity Type | Organization
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Legal Business Name | ROCKWALL PHYSICAL MEDICINE PLLC
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Dates
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Enumeration Date | 02/15/2022
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Last Update Date | 09/23/2022
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Provider Practice Location Address
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Address Line | 1141 RIDGE RD STE A
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City | ROCKWALL
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State | TX
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Zip | 75087-4217
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Country | US
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Telephone | 972-771-9844
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Fax | 972-771-4674
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Provider Business Mailing Address
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Address Line | PO BOX 2526
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City | ROCKWALL
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State | TX
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Zip | 75087-9026
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Country | US
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Telephone | 903-268-6965
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Fax | 972-771-4674
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Authorized Official
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Title or Position | OWNER
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Name | TIMOTHY DAVID PAYNE
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Credential | DC
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Telephone | 903-268-6965
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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