MEDICARE: CAMILLE MARIE LIRA

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	225100000X	Physical Therapist	05015703A	IN

General Provider Information

NPI Number	:	1841023371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILLE MARIE LIRA

Provider Business Mailing Address
First Line	:	155 POPE ST APT B
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-4037
Country	:	US
Telephone Number	:	951-818-3289
Fax Number	:

Provider Business Practice Location Address
First Line	:	9525 N MERIDIAN ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1310
Country	:	US
Telephone Number	:	951-818-3289
Fax Number	:

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

Provider Enumeration Date	:	08/21/2024
Last Update Date	:	10/24/2025

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Directions to “ CAMILLE MARIE LIRA ” Practice Location

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