Provider Demographics
NPI:1790514016
Name:DAIN, THALIA DE JESUS (LAC, LMT)
Entity type:Individual
Prefix:
First Name:THALIA
Middle Name:DE JESUS
Last Name:DAIN
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ROSS RD
Mailing Address - Street 2:
Mailing Address - City:ROLLINSFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03869-5910
Mailing Address - Country:US
Mailing Address - Phone:603-534-2334
Mailing Address - Fax:
Practice Address - Street 1:314B CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-4133
Practice Address - Country:US
Practice Address - Phone:603-534-2334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8267225700000X
NH332171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist