Healthcare Provider Details

I. General information

NPI: 1669455275
Provider Name (Legal Business Name): JUDY NUTTALL O'DONNELL P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JUDY LYNN O'DONNELL P.T.

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LRMC, CMR 402, BOX 927
LANDSTUHL GERMANY
66789
DE

IV. Provider business mailing address

CMR 402 BOX 927
APO AE
09180-0927
US

V. Phone/Fax

Practice location:
  • Phone: 314-493-4086
  • Fax: 314-493-4236
Mailing address:
  • Phone: 314-493-4086
  • Fax: 314-493-4236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1026458
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: