Provider Demographics
NPI:1063567600
Name:LAYMON, SHAWNNA MARIE (PTA)
Entity type:Individual
Prefix:MRS
First Name:SHAWNNA
Middle Name:MARIE
Last Name:LAYMON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57934 JUAREZ DR
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-6313
Mailing Address - Country:US
Mailing Address - Phone:760-365-9620
Mailing Address - Fax:
Practice Address - Street 1:56299 29 PALMS HWY
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-2857
Practice Address - Country:US
Practice Address - Phone:760-369-1743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT4216225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant