Provider Demographics
NPI:1780009993
Name:POMYCALA, JORDAIN LAYNE (MS LAT ATC)
Entity Type:Individual
Prefix:MRS
First Name:JORDAIN
Middle Name:LAYNE
Last Name:POMYCALA
Suffix:
Gender:F
Credentials:MS LAT ATC
Other - Prefix:
Other - First Name:JORDAIN
Other - Middle Name:LAYNE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS LAT ATC
Mailing Address - Street 1:300 CRAIGDELL RD
Mailing Address - Street 2:APT. 404
Mailing Address - City:NEW KENSINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15068-3054
Mailing Address - Country:US
Mailing Address - Phone:412-992-1911
Mailing Address - Fax:
Practice Address - Street 1:2757 LEECHBURG RD
Practice Address - Street 2:
Practice Address - City:LOWER BURRELL
Practice Address - State:PA
Practice Address - Zip Code:15068-3138
Practice Address - Country:US
Practice Address - Phone:724-337-6522
Practice Address - Fax:724-337-0630
Is Sole Proprietor?:No
Enumeration Date:2014-02-25
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0053402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer