Provider Demographics
NPI:1508680422
Name:DAUZAT, LONTINA (TINA ) INA (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:LONTINA (TINA )
Middle Name:INA
Last Name:DAUZAT
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:DAUZAT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MASSAGE THERAPIST
Mailing Address - Street 1:3160 MILITARY HWY
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-4225
Mailing Address - Country:US
Mailing Address - Phone:318-792-7178
Mailing Address - Fax:
Practice Address - Street 1:3160 MILITARY HWY
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-4225
Practice Address - Country:US
Practice Address - Phone:318-792-7178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA7613225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist