Provider Demographics
NPI:1710336177
Name:LAYMAN, MIRANDA (MS, ATC)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:LAYMAN
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 HARTWOOD CV
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-6009
Mailing Address - Country:US
Mailing Address - Phone:217-962-1740
Mailing Address - Fax:
Practice Address - Street 1:1500 PEACHTREE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1754
Practice Address - Country:US
Practice Address - Phone:601-965-7003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAT0552255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer