Provider Demographics
NPI:1063685683
Name:PALENCIK, GREG
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:PALENCIK
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 1:3029 MATHERS WAY
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-2641
Mailing Address - Country:US
Mailing Address - Phone:330-646-7108
Mailing Address - Fax:
Practice Address - Street 1:1485 INTERNATIONAL PARKWAY
Practice Address - Street 2:VOYAGE STAFFING
Practice Address - City:HEATHROW
Practice Address - State:FL
Practice Address - Zip Code:32746
Practice Address - Country:US
Practice Address - Phone:800-798-6035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH070016240225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist