Provider Demographics
NPI:1801371117
Name:TREADAWAY, LAYKN DANIELLE (PTA)
Entity Type:Individual
Prefix:
First Name:LAYKN
Middle Name:DANIELLE
Last Name:TREADAWAY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 OLD BRICKYARD RD
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-8971
Mailing Address - Country:US
Mailing Address - Phone:336-928-0066
Mailing Address - Fax:
Practice Address - Street 1:204 OLD BRICKYARD RD
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-8971
Practice Address - Country:US
Practice Address - Phone:336-667-3986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA5609225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC$$$$$$$$$OtherCONSONUS