Provider Demographics
NPI:1235778556
Name:GRELLMANN, SHELLY MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:MARIE
Last Name:GRELLMANN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6480 HARRISON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-7961
Mailing Address - Country:US
Mailing Address - Phone:137-131-7795
Mailing Address - Fax:513-854-9921
Practice Address - Street 1:3205 WOODMAN DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45420-1143
Practice Address - Country:US
Practice Address - Phone:937-298-4417
Practice Address - Fax:937-298-8260
Is Sole Proprietor?:No
Enumeration Date:2020-01-03
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT019701225100000X
MI5501019417225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0007779Medicaid