Provider Demographics
NPI:1619618980
Name:LAYLON, RONALD JR (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:LAYLON
Suffix:JR
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2195 LENTICULAR DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89441-4865
Mailing Address - Country:US
Mailing Address - Phone:775-240-0895
Mailing Address - Fax:
Practice Address - Street 1:FORT LEWIS LANCER PERFORMANCE CENTER
Practice Address - Street 2:11371 22ND ST
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98433
Practice Address - Country:US
Practice Address - Phone:775-240-0895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-02
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAA1613050382255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program