Provider Demographics
NPI:1649001678
Name:BLAHNIK-ELLIOTT, GINA RENAE (LMT)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:RENAE
Last Name:BLAHNIK-ELLIOTT
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11545 CEPHEUS RD
Mailing Address - Street 2:
Mailing Address - City:BELLEMONT
Mailing Address - State:AZ
Mailing Address - Zip Code:86015-1016
Mailing Address - Country:US
Mailing Address - Phone:406-241-3616
Mailing Address - Fax:
Practice Address - Street 1:710 N BEAVER ST BLDG 3
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3147
Practice Address - Country:US
Practice Address - Phone:928-226-1556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-30035225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist