Provider Demographics
NPI:1952790610
Name:LAYCOCK, ABBIE (DPT)
Entity Type:Individual
Prefix:
First Name:ABBIE
Middle Name:
Last Name:LAYCOCK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5731 COTTONWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3723
Mailing Address - Country:US
Mailing Address - Phone:360-456-1072
Mailing Address - Fax:360-459-9954
Practice Address - Street 1:8750 TALLON LN NE STE C
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-6608
Practice Address - Country:US
Practice Address - Phone:360-456-1072
Practice Address - Fax:360-459-9954
Is Sole Proprietor?:No
Enumeration Date:2015-01-20
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP15393225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist