Provider Demographics
NPI:1992455562
Name:DOMINICK, ELORA NACHELLE (LMT)
Entity type:Individual
Prefix:MS
First Name:ELORA
Middle Name:NACHELLE
Last Name:DOMINICK
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 1:3909 THALIA ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70125-2007
Mailing Address - Country:US
Mailing Address - Phone:404-593-9892
Mailing Address - Fax:
Practice Address - Street 1:3909 THALIA ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70125-2007
Practice Address - Country:US
Practice Address - Phone:404-593-9892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-26
Last Update Date:2022-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA9413225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist