Provider Demographics
NPI:1295402071
Name:COURTER, LAYNE AVERY (ATC)
Entity type:Individual
Prefix:
First Name:LAYNE
Middle Name:AVERY
Last Name:COURTER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6338 LITTLE SORREL DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-4480
Mailing Address - Country:US
Mailing Address - Phone:804-839-0779
Mailing Address - Fax:
Practice Address - Street 1:1839 ASHTON LN APT 177B
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-8132
Practice Address - Country:US
Practice Address - Phone:804-839-0779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0064662255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer