Provider Demographics
NPI:1104711506
Name:ALTAYR, DIONNA (LMT,MMP)
Entity type:Individual
Prefix:
First Name:DIONNA
Middle Name:
Last Name:ALTAYR
Suffix:
Gender:F
Credentials:LMT,MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:963 QUEEN ST STE E
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-1282
Mailing Address - Country:US
Mailing Address - Phone:860-849-4119
Mailing Address - Fax:
Practice Address - Street 1:963 QUEEN ST STE E
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-1282
Practice Address - Country:US
Practice Address - Phone:860-849-4119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10070225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist