MEDICARE: MRS. LAURA S DYER L.M.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172M00000X	Mechanotherapist	MT001551	GA

General Provider Information

NPI Number	:	1598088692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA S DYER L.M.T.

Provider Business Mailing Address
First Line	:	1510 N THORNTON AVE
Second Line	:	STE. 214
City	:	DALTON
State	:	GA
Zip	:	30720-8517
Country	:	US
Telephone Number	:	706-275-0543
Fax Number	:

Provider Business Practice Location Address
First Line	:	1510 N THORNTON AVE
Second Line	:	STE. 214
City	:	DALTON
State	:	GA
Zip	:	30720-8517
Country	:	US
Telephone Number	:	706-275-0543
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2010
Last Update Date	:	03/04/2010

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