Healthcare Provider Details

I. General information

NPI: 1740116847
Provider Name (Legal Business Name): THELMA GAILLARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 PARK ST STE 101
COLUMBIA SC
29201-2011
US

IV. Provider business mailing address

2000 PARK ST STE 101
COLUMBIA SC
29201-2011
US

V. Phone/Fax

Practice location:
  • Phone: 843-926-2011
  • Fax:
Mailing address:
  • Phone: 843-926-2011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7831
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: