Provider Demographics
NPI:1215285796
Name:GRELLMANN, MARICELA M (LMT)
Entity type:Individual
Prefix:
First Name:MARICELA
Middle Name:M
Last Name:GRELLMANN
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 1:2625 BLUEBIRD AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-4773
Mailing Address - Country:US
Mailing Address - Phone:956-225-5689
Mailing Address - Fax:956-585-4658
Practice Address - Street 1:2520 E EXPRESSWAY 83
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6696
Practice Address - Country:US
Practice Address - Phone:956-225-5689
Practice Address - Fax:956-585-4658
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT105304173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist