Provider Demographics
NPI:1114062825
Name:ORENCHUK, BRYAN RUSSELL (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:RUSSELL
Last Name:ORENCHUK
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CROSS STREET
Mailing Address - Street 2:
Mailing Address - City:BURGETTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15021-1061
Mailing Address - Country:US
Mailing Address - Phone:412-417-3561
Mailing Address - Fax:
Practice Address - Street 1:433 CASTLE SHANNON BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15234-1405
Practice Address - Country:US
Practice Address - Phone:412-344-9044
Practice Address - Fax:412-344-9047
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART001919A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer