Provider Demographics
NPI:1235416884
Name:RELOS, REOWELL
Entity Type:Individual
Prefix:MR
First Name:REOWELL
Middle Name:
Last Name:RELOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1296 CROW WAY
Mailing Address - Street 2:APT 100
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-6464
Mailing Address - Country:US
Mailing Address - Phone:413-344-7502
Mailing Address - Fax:
Practice Address - Street 1:25 ADAMS RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:MA
Practice Address - Zip Code:01267-2928
Practice Address - Country:US
Practice Address - Phone:413-458-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009092225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist