Provider Demographics
NPI:1669019402
Name:CALHOUN, DANA GAYE (LMT)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:GAYE
Last Name:CALHOUN
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 1:1991 LYSTER LN
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-1450
Mailing Address - Country:US
Mailing Address - Phone:248-506-1106
Mailing Address - Fax:
Practice Address - Street 1:28919 EVERGREEN RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-5902
Practice Address - Country:US
Practice Address - Phone:248-506-1106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-27
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501008326225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty