Basic Information
| Provider Information | |||||||||
| NPI: | 1063461440 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAYNE PHYSICAL THERAPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 295 BROKEN FENCE RD | ||||||||
| Address2: | |||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 803029607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7204586555 | ||||||||
| FaxNumber: | 3032748063 | ||||||||
| Practice Location | |||||||||
| Address1: | 2801 YOUNGFIELD ST STE 390 | ||||||||
| Address2: | |||||||||
| City: | GOLDEN | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804012265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7204586555 | ||||||||
| FaxNumber: | 3032748063 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 07/14/2020 | ||||||||
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| AuthorizedOfficialLastName: | LAYNE | ||||||||
| AuthorizedOfficialFirstName: | DEBRA | ||||||||
| AuthorizedOfficialMiddleName: | JAN | ||||||||
| AuthorizedOfficialTitleorPosition: | CO OWNER, MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 3036016666 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
| NPICertificationDate: | 07/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | N | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.