Provider Demographics
NPI:1962110676
Name:LAYNE, CARLEY (PTA)
Entity type:Individual
Prefix:
First Name:CARLEY
Middle Name:
Last Name:LAYNE
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 1:3714 BROWNS HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:TRACY CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37387-3034
Mailing Address - Country:US
Mailing Address - Phone:423-255-9265
Mailing Address - Fax:
Practice Address - Street 1:105 SUNRISE CIR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-8246
Practice Address - Country:US
Practice Address - Phone:423-255-9265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8219225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN117586961OtherDRIVER LICENSE