Provider Demographics
NPI:1013933662
Name:MICHAEL PALENCHAR
Entity Type:Organization
Organization Name:MICHAEL PALENCHAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:PALENCHAR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:410-714-3903
Mailing Address - Street 1:1504F PEMBERTON DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-2475
Mailing Address - Country:US
Mailing Address - Phone:410-714-3903
Mailing Address - Fax:
Practice Address - Street 1:1504F PEMBERTON DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-2475
Practice Address - Country:US
Practice Address - Phone:410-714-3903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21836261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy