Provider Demographics
NPI:1255486262
Name:HAYWORTH, DANA LYNN
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:LYNN
Last Name:HAYWORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:DANA
Other - Middle Name:LYNN
Other - Last Name:HAYWORTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:9827 N WOODLAWN ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:67147-8582
Mailing Address - Country:US
Mailing Address - Phone:316-681-0824
Mailing Address - Fax:316-219-1349
Practice Address - Street 1:9727 E SHANNON WOODS CIR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-4102
Practice Address - Country:US
Practice Address - Phone:316-681-0824
Practice Address - Fax:316-219-1349
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11009812251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic