Provider Demographics
NPI:1720532427
Name:LAYNES, JEFFERY
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:
Last Name:LAYNES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JEFFERY
Other - Middle Name:
Other - Last Name:LAYNES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PERSONAL TRAINER
Mailing Address - Street 1:6000 MONADNOCK WAY
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-1708
Mailing Address - Country:US
Mailing Address - Phone:510-301-1391
Mailing Address - Fax:
Practice Address - Street 1:800 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:CA
Practice Address - Zip Code:94611-4029
Practice Address - Country:US
Practice Address - Phone:510-301-1391
Practice Address - Fax:510-632-6258
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT-1402512255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer