Healthcare Provider Details

I. General information

NPI: 1851195358
Provider Name (Legal Business Name): ALLISON O'DEA PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1536 TIMBER RIDGE AVE
LEESVILLE LA
71446-9451
US

IV. Provider business mailing address

1536 TIMBER RIDGE AVE
LEESVILLE LA
71446-9451
US

V. Phone/Fax

Practice location:
  • Phone: 803-609-5091
  • Fax:
Mailing address:
  • Phone: 803-609-5091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALLISON O'DEA
Title or Position: OWNER
Credential: DPT
Phone: 803-609-5091