Healthcare Provider Details

I. General information

NPI: 1073482717
Provider Name (Legal Business Name): DIA DE MASSAGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 MADISON ST NE
ALBUQUERQUE NM
87108-1238
US

IV. Provider business mailing address

135 MADISON ST NE
ALBUQUERQUE NM
87108-1238
US

V. Phone/Fax

Practice location:
  • Phone: 505-450-3382
  • Fax:
Mailing address:
  • Phone: 505-450-3382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH DILLARD
Title or Position: LICENSED MASSAGE THERAPIST/OWNER
Credential: LMT
Phone: 505-450-3382