Provider Demographics
NPI:1053944413
Name:DEMONS, SHENISE RACHELLE (DPT)
Entity type:Individual
Prefix:
First Name:SHENISE
Middle Name:RACHELLE
Last Name:DEMONS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33900 HARPER AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-350-2644
Mailing Address - Fax:
Practice Address - Street 1:1867 HARVARD AVE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30337-3526
Practice Address - Country:US
Practice Address - Phone:404-835-4321
Practice Address - Fax:404-835-4320
Is Sole Proprietor?:No
Enumeration Date:2020-02-13
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH11130225100000X
GAPT014552225100000X
NCP19401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist