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General NPI Number Information
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NPI Number | 1235448812
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Entity Type | Individual
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Provider Name | ADAM ODONISH DPT
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Gender | Male
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Dates
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Enumeration Date | 09/30/2010
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Last Update Date | 04/13/2021
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Provider Practice Location Address
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Address Line | 261 RICHMOND RD
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City | RICHMOND HEIGHTS
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State | OH
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Zip | 44143-4422
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Country | US
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Telephone | 814-335-0936
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Fax |
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Provider Business Mailing Address
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Address Line | 4384 ZACKARY CT
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City | WILLOUGHBY
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State | OH
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Zip | 44094-7870
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Country | US
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Telephone | 814-335-0936
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PT24852
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License Number State | FL
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