Provider Demographics
NPI:1083906234
Name:LAYMAN, TIMOTHY VAN
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:VAN
Last Name:LAYMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 N 350 W
Mailing Address - Street 2:
Mailing Address - City:SUNSET
Mailing Address - State:UT
Mailing Address - Zip Code:84015-2713
Mailing Address - Country:US
Mailing Address - Phone:801-866-6460
Mailing Address - Fax:
Practice Address - Street 1:3742 W 4000 S
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:UT
Practice Address - Zip Code:84401-9630
Practice Address - Country:US
Practice Address - Phone:435-723-1799
Practice Address - Fax:435-723-2521
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-06
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency