Provider Demographics
NPI:1235295858
Name:LORENTZ, PAMILA A
Entity type:Individual
Prefix:MS
First Name:PAMILA
Middle Name:A
Last Name:LORENTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAMILA
Other - Middle Name:A
Other - Last Name:LORENTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, RN, LMBT
Mailing Address - Street 1:7210L BROAD RIVER RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-7973
Mailing Address - Country:US
Mailing Address - Phone:803-749-1576
Mailing Address - Fax:803-749-1676
Practice Address - Street 1:7210L BROAD RIVER RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-7973
Practice Address - Country:US
Practice Address - Phone:803-749-1576
Practice Address - Fax:803-749-1676
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4523225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist