Basic Information
| Provider Information | |||||||||
| NPI: | 1134406119 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAYGO | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | ETHIER | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT, DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ETHIER | ||||||||
| OtherFirstName: | DANIELLE | ||||||||
| OtherMiddleName: | ALLYSE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PT, DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1910 N CHURCH ST | ||||||||
| Address2: | STE D | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274055666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362747480 | ||||||||
| FaxNumber: | 3362748903 | ||||||||
| Practice Location | |||||||||
| Address1: | 1910 N CHURCH ST | ||||||||
| Address2: | STE D | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274055666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362747480 | ||||||||
| FaxNumber: | 3362748903 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2011 | ||||||||
| LastUpdateDate: | 02/19/2013 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | J1-0002777 | DE | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | P13704 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.