Provider Demographics
NPI:1669678389
Name:SOENKSEN, WADE (PT, DPT, OCS, ATC)
Entity Type:Individual
Prefix:DR
First Name:WADE
Middle Name:
Last Name:SOENKSEN
Suffix:
Gender:M
Credentials:PT, DPT, OCS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2829 MILLWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-1261
Mailing Address - Country:US
Mailing Address - Phone:803-851-3506
Mailing Address - Fax:803-619-9551
Practice Address - Street 1:550 SPEARS CREEK CHURCH RD STE C
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:SC
Practice Address - Zip Code:29045-8132
Practice Address - Country:US
Practice Address - Phone:803-233-3183
Practice Address - Fax:803-233-3183
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070024248225100000X
IL0960049152255A2300X
SC11893225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer