Provider Demographics
NPI:1760489512
Name:LAYNE, TED NEIL (PT)
Entity Type:Individual
Prefix:MR
First Name:TED
Middle Name:NEIL
Last Name:LAYNE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
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:303-449-3431
Mailing Address - Fax:303-447-3390
Practice Address - Street 1:3000 CENTER GREEN DR
Practice Address - Street 2:110
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2364
Practice Address - Country:US
Practice Address - Phone:303-449-3431
Practice Address - Fax:303-447-3390
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2008-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1542225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1542OtherPHYSICAL THERAPY LICENSE
CO1542OtherPHYSICAL THERAPY LICENSE