Healthcare Provider Details

I. General information

NPI: 1982909479
Provider Name (Legal Business Name): DARLENE A O'DELL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2011
Last Update Date: 01/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1134 STATE ROUTE 29
GREENWICH NY
12834-6107
US

IV. Provider business mailing address

100 PARK ST
GLENS FALLS NY
12801-4413
US

V. Phone/Fax

Practice location:
  • Phone: 518-692-9861
  • Fax: 518-692-7947
Mailing address:
  • Phone: 518-926-2000
  • Fax: 518-926-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number009259-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: