Healthcare Provider Details

I. General information

NPI: 1760803357
Provider Name (Legal Business Name): JOSEF GABRIEL RELLORA D.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2013
Last Update Date: 12/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 ROPER CREEK DR
GREENVILLE SC
29615-6927
US

IV. Provider business mailing address

221 FAIRFOREST WAY APT 36103
GREENVILLE SC
29607-7406
US

V. Phone/Fax

Practice location:
  • Phone: 864-286-9966
  • Fax:
Mailing address:
  • Phone: 843-810-7950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6677
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: