Provider Demographics
NPI:1821348806
Name:LAYMONSMITH, VIKKI L (LCM)
Entity Type:Individual
Prefix:
First Name:VIKKI
Middle Name:L
Last Name:LAYMONSMITH
Suffix:
Gender:F
Credentials:LCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 PANOLA CT
Mailing Address - Street 2:
Mailing Address - City:ROYSE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75189-5012
Mailing Address - Country:US
Mailing Address - Phone:214-994-8843
Mailing Address - Fax:
Practice Address - Street 1:2827 MARKET CENTER DR STE 219
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032
Practice Address - Country:US
Practice Address - Phone:214-994-8843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2018-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT114429225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMT114429OtherLICENSE #