Provider Demographics
NPI:1477189348
Name:ELENIS, DAYNA NICHOLE (AT, ATC, LMT)
Entity type:Individual
Prefix:
First Name:DAYNA
Middle Name:NICHOLE
Last Name:ELENIS
Suffix:
Gender:F
Credentials:AT, ATC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2077 FERNLOCK DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-4421
Mailing Address - Country:US
Mailing Address - Phone:248-840-9710
Mailing Address - Fax:
Practice Address - Street 1:690 AMSTERDAM ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3410
Practice Address - Country:US
Practice Address - Phone:313-651-1910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2601003222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer