MEDICARE: PAYTON LANE GRAHAM DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	24678	NC

General Provider Information

NPI Number	:	1639022239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAYTON LANE GRAHAM DPT

Provider Business Mailing Address
First Line	:	1721 ALLENS LN STE 101
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-3662
Country	:	US
Telephone Number	:	910-256-4443
Fax Number	:

Provider Business Practice Location Address
First Line	:	1721 ALLENS LN STE 101
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-3662
Country	:	US
Telephone Number	:	910-256-4443
Fax Number	:	910-256-4443

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2026
Last Update Date	:	02/16/2026

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Directions to “ PAYTON LANE GRAHAM DPT” Practice Location

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