Provider Demographics
NPI:1366606121
Name:PAYNE, MICHAEL S (DPT)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:PAYNE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 COMMERCE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-7059
Mailing Address - Country:US
Mailing Address - Phone:910-757-0408
Mailing Address - Fax:910-757-0413
Practice Address - Street 1:292 COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-7059
Practice Address - Country:US
Practice Address - Phone:910-757-0408
Practice Address - Fax:910-757-0413
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2021-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10701225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ50147E687Medicare PIN
VA009697R87Medicare PIN