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General NPI Number Information
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NPI Number | 1124305966
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Entity Type | Organization
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Legal Business Name | O'DONNELL PHYSICAL THERAPY CORP.
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Dates
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Enumeration Date | 11/08/2011
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Last Update Date | 11/08/2011
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Provider Practice Location Address
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Address Line | 108 VAN WINKLE CT
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City | FOLSOM
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State | CA
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Zip | 95630-1962
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Country | US
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Telephone | 916-847-3548
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Fax | 916-988-1106
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Provider Business Mailing Address
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Address Line | 108 VAN WINKLE CT
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City | FOLSOM
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State | CA
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Zip | 95630-1962
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Country | US
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Telephone | 916-847-3548
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Fax | 916-988-1106
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Authorized Official
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Title or Position | PRESIDENT AND SECRETARY
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Name | STEVEN O'DONNELL
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Credential | PT
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Telephone | 916-847-3548
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT27002
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License Number State | CA
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