Provider Demographics
NPI:1588789713
Name:PAYNE, KERRI (RPT)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:
Other - Last Name:MICONI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:6 ALFRED DR
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-4725
Mailing Address - Country:US
Mailing Address - Phone:401-245-2667
Mailing Address - Fax:
Practice Address - Street 1:4901 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-2080
Practice Address - Country:US
Practice Address - Phone:508-675-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9967225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist