Provider Demographics
NPI:1184099319
Name:PAYNE, ANNA (DPT)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39400 PASEO PADRE PKWY
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2310
Mailing Address - Country:US
Mailing Address - Phone:510-248-3000
Mailing Address - Fax:
Practice Address - Street 1:1650 S AMPHLETT BLVD
Practice Address - Street 2:#108
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2517
Practice Address - Country:US
Practice Address - Phone:650-638-9142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-14
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43348225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist