Provider Demographics
NPI:1043014202
Name:PAYNE, SEAN (PTA)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:PAYNE
Suffix:
Gender:
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11937-2077
Mailing Address - Country:US
Mailing Address - Phone:585-697-4863
Mailing Address - Fax:
Practice Address - Street 1:300 PANTIGO PL STE 112
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11937-5927
Practice Address - Country:US
Practice Address - Phone:631-329-1828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010749-01225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant