Healthcare Provider Details

I. General information

NPI: 1568320133
Provider Name (Legal Business Name): DAWN GILLREATH LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2026
Last Update Date: 01/13/2026
Certification Date: 01/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 LYNCH CT NW
ALBUQUERQUE NM
87104-2148
US

IV. Provider business mailing address

1015 LYNCH CT NW
ALBUQUERQUE NM
87104-2148
US

V. Phone/Fax

Practice location:
  • Phone: 505-659-2091
  • Fax:
Mailing address:
  • Phone: 505-659-2091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6532
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: