Payne Wagner, Melissa S

Payne Wagner, Melissa S is an individual health care provider with primary practice located at 3266 Sycamore Rd , Dekalb IL 60115-9621. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as her primary health care specialty. Payne Wagner, Melissa S can be contacted via phone (815) 756-8524.

Contact Information

Primary practice address
3266 Sycamore Rd Dekalb IL 60115-9621
Phone: (815) 756-8524
Fax: (815) 756-1841
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 070013020 Illinois

Profile Details

NPI number 1811972805
LBN Legal business name Payne Wagner, Melissa S
Credentials Physical Therapist (PT)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 13th, 2005
Last updated Apr 26th, 2017 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1811972805 NPPES
Other 650023317 RAILROAD MEDICARE

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