Provider Demographics
NPI:1700401353
Name:GRAY, THALIA (LAC, DIPLOOM, PHD)
Entity Type:Individual
Prefix:
First Name:THALIA
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:LAC, DIPLOOM, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 SUMMERLEA ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-1910
Mailing Address - Country:US
Mailing Address - Phone:412-398-2887
Mailing Address - Fax:
Practice Address - Street 1:801 N NEGLEY AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-1560
Practice Address - Country:US
Practice Address - Phone:412-206-9865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOM000281171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist