Provider Demographics
NPI:1063461440
Name:LAYNE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:LAYNE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER, MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:JAN
Authorized Official - Last Name:LAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:303-601-6666
Mailing Address - Street 1:295 BROKEN FENCE RD
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-9607
Mailing Address - Country:US
Mailing Address - Phone:720-458-6555
Mailing Address - Fax:303-274-8063
Practice Address - Street 1:2801 YOUNGFIELD ST STE 390
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-2265
Practice Address - Country:US
Practice Address - Phone:720-458-6555
Practice Address - Fax:303-274-8063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC804373Medicare PIN