Provider Demographics
NPI:1396773412
Name:MCCALL STAFFORD, LAYLA (PT, DPT, ATC, LAT)
Entity type:Individual
Prefix:DR
First Name:LAYLA
Middle Name:
Last Name:MCCALL STAFFORD
Suffix:
Gender:F
Credentials:PT, DPT, ATC, LAT
Other - Prefix:MS
Other - First Name:LAYLA
Other - Middle Name:M
Other - Last Name:MCCALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAT, ATC
Mailing Address - Street 1:9201 UNIVERSITY CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28223-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9201 UNIVERSITY CITY BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28223-0001
Practice Address - Country:US
Practice Address - Phone:704-687-7432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8272255A2300X
NCPT11537225100000X
NCATC12622255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA2255A2300XOtherATHLETIC TRAINER