Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081S0010X | Sports Medicine | 1636 | AL |
N | 213ES0000X | Sports Medicine | 1636 | AL |
Y | 225100000X | Physical Therapist | PTH10354 | AL |
NPI | 1154823029 |
---|---|
Provider Name | Taylor Payne |
First Address | Hoover, AL 35242-2660 |
Second Address | Birmingham, AL 35235-3154 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2018 |
Last Update Date | 24/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PTH10354 | PHYSICAL THERAPY LICENSE (01) | AL |