Healthcare Provider Details

I. General information

NPI: 1811514672
Provider Name (Legal Business Name): JOSHUA CHARLES LAYMAN PT, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2020
Last Update Date: 06/28/2020
Certification Date: 06/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 S SPRINGFIELD AVE
BOLIVAR MO
65613-9686
US

IV. Provider business mailing address

701 NORTHVIEW RD
MARSHFIELD MO
65706-8978
US

V. Phone/Fax

Practice location:
  • Phone: 417-328-1472
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number2001013797
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: