MEDICARE: MRS. LHYRA DAWIS MAYORALGO PT

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	171W00000X	Contractor	05009021A	IN

General Provider Information

NPI Number	:	1003940990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LHYRA DAWIS MAYORALGO PT

Provider Business Mailing Address
First Line	:	2734 PAINTED DESERT RUN
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46808-3560
Country	:	US
Telephone Number	:	317-656-9654
Fax Number	:	317-656-9654

Provider Business Practice Location Address
First Line	:	3512 STELLHORN RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-4631
Country	:	US
Telephone Number	:	260-483-9081
Fax Number	:

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

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	02/19/2012

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