Provider Demographics
NPI:1558339416
Name:OLENCHUK, PAMELA (PT)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:
Last Name:OLENCHUK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 843446
Mailing Address - Street 2:HEALTHTOUCH, LLC
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-3446
Mailing Address - Country:US
Mailing Address - Phone:803-227-8007
Mailing Address - Fax:803-996-3180
Practice Address - Street 1:MOORE ORTHOPAEDIC CLINIC, P.A.
Practice Address - Street 2:14 MEDICAL PARK SUITE 200
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-227-8007
Practice Address - Fax:803-996-3180
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1721225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1721OtherPT LICENSE #