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NPI Code Detail

MEDICARE: DR. ADAM ODONISH DPT

MEDICARE: DR. ADAM ODONISH DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistPT24852FL

General Provider Information

NPI Number : 1235448812
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ADAM ODONISH DPT
Provider Business Mailing Address
First Line : 4384 ZACKARY CT
Second Line :
City : WILLOUGHBY
State : OH
Zip : 44094-7870
Country : US
Telephone Number : 814-335-0936
Fax Number :
Provider Business Practice Location Address
First Line : 261 RICHMOND RD
Second Line :
City : RICHMOND HEIGHTS
State : OH
Zip : 44143-4422
Country : US
Telephone Number : 814-335-0936
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2010
Last Update Date : 04/13/2021

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