Provider Demographics
NPI:1124860960
Name:DIAS, KHANA (LMT)
Entity type:Individual
Prefix:
First Name:KHANA
Middle Name:
Last Name:DIAS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10404 W COGGINS DR STE 110
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3465
Mailing Address - Country:US
Mailing Address - Phone:623-777-9919
Mailing Address - Fax:
Practice Address - Street 1:10404 W COGGINS DR STE 110
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3465
Practice Address - Country:US
Practice Address - Phone:623-777-9919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-18363225700000X, 173C00000X
261QP3300X, 261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No173C00000XOther Service ProvidersReflexologistGroup - Multi-Specialty