Healthcare Provider Details

I. General information

NPI: 1457357089
Provider Name (Legal Business Name): JOHN EDWARD LAYNE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 LA RUE FRANCE STE 300
LAFAYETTE LA
70508-3144
US

IV. Provider business mailing address

101 LA RUE FRANCE STE 500
LAFAYETTE LA
70508-3144
US

V. Phone/Fax

Practice location:
  • Phone: 337-269-5929
  • Fax:
Mailing address:
  • Phone: 337-269-9828
  • Fax: 337-234-1075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5567
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number07068R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: