Provider Demographics
NPI:1467185355
Name:WAITES, DAWN (LMT)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:WAITES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137A RANGE RD
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:NH
Mailing Address - Zip Code:03809-4928
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:90 AIRPORT RD UNIT 8
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5356
Practice Address - Country:US
Practice Address - Phone:603-867-2470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8217225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty