MEDICARE: MS. DANA LYNN HAYWORTH

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	2251X0800X	Orthopedic Physical Therapist	1100981	KS

General Provider Information

NPI Number	:	1255486262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DANA LYNN HAYWORTH

Provider Business Mailing Address
First Line	:	9827 N WOODLAWN ST
Second Line	:
City	:	VALLEY CENTER
State	:	KS
Zip	:	67147-8582
Country	:	US
Telephone Number	:	316-681-0824
Fax Number	:	316-219-1349

Provider Business Practice Location Address
First Line	:	9727 E SHANNON WOODS CIR
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67226-4102
Country	:	US
Telephone Number	:	316-681-0824
Fax Number	:	316-219-1349

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	07/08/2007

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