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General NPI Number Information
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NPI Number | 1700401353
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Entity Type | Individual
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Provider Name | THALIA GRAY LAC, DIPLOOM, PHD
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Gender | Female
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Dates
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Enumeration Date | 06/10/2020
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Last Update Date | 06/10/2020
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Provider Practice Location Address
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Address Line | 801 N NEGLEY AVE
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City | PITTSBURGH
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State | PA
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Zip | 15206-1560
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Country | US
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Telephone | 412-206-9865
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Fax |
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Provider Business Mailing Address
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Address Line | 626 SUMMERLEA ST
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City | PITTSBURGH
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State | PA
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Zip | 15232-1910
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Country | US
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Telephone | 412-398-2887
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | OM000281
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License Number State | PA
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