Provider Demographics
NPI:1770648461
Name:TRAINA, DENICE
Entity Type:Individual
Prefix:
First Name:DENICE
Middle Name:
Last Name:TRAINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 BOHLER AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-3794
Mailing Address - Country:US
Mailing Address - Phone:706-724-3355
Mailing Address - Fax:775-806-9891
Practice Address - Street 1:631 BOHLER AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-3794
Practice Address - Country:US
Practice Address - Phone:706-736-4738
Practice Address - Fax:775-806-9891
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-25
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002115225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist