Provider Demographics
NPI:1861420234
Name:PAYNE, RHONDA KAY (PTA)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:KAY
Last Name:PAYNE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 LERA
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-2629
Mailing Address - Country:US
Mailing Address - Phone:580-772-3200
Mailing Address - Fax:580-772-1061
Practice Address - Street 1:1400 LERA
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-2629
Practice Address - Country:US
Practice Address - Phone:580-772-3200
Practice Address - Fax:580-772-1061
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK813225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant