Healthcare Provider Details

I. General information

NPI: 1124487871
Provider Name (Legal Business Name): PATRICK CLARK O'DONNELL III ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2016
Last Update Date: 09/14/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 CHAMPIONS DRIVE
PITTSBURGH PA
15213
US

IV. Provider business mailing address

3217 SUNDALE DR
GLENSHAW PA
15116-1127
US

V. Phone/Fax

Practice location:
  • Phone: 412-535-2732
  • Fax:
Mailing address:
  • Phone: 219-588-0833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT008748
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: