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General NPI Number Information
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NPI Number | 1477189348
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Entity Type | Individual
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Provider Name | DAYNA NICHOLE ELENIS AT, ATC, LMT
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Gender | Female
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Dates
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Enumeration Date | 03/23/2020
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Last Update Date | 03/23/2020
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Provider Practice Location Address
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Address Line | 690 AMSTERDAM ST
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City | DETROIT
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State | MI
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Zip | 48202-3410
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Country | US
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Telephone | 313-651-1910
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Fax |
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Provider Business Mailing Address
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Address Line | 2077 FERNLOCK DR
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City | OXFORD
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State | MI
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Zip | 48371-4421
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Country | US
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Telephone | 248-840-9710
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 260100322
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License Number State | MI
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