Provider Demographics
NPI:1124086913
Name:PERELLA, ANTHONY COREY (DPT)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:COREY
Last Name:PERELLA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1943 GLENNS BAY ROAD
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29575-4406
Mailing Address - Country:US
Mailing Address - Phone:843-650-1162
Mailing Address - Fax:
Practice Address - Street 1:1943 GLENNS BAY RD
Practice Address - Street 2:
Practice Address - City:SURFSIDE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575-4833
Practice Address - Country:US
Practice Address - Phone:843-650-1162
Practice Address - Fax:843-650-1174
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4431225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ340348390Medicare PIN