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General NPI Number Information
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NPI Number | 1669495594
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Entity Type | Individual
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Provider Name | DONELLE LEE ODREN PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 10/31/2011
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Provider Practice Location Address
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Address Line | 11915 E BROADWAY AVE STE 100
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City | SPOKANE VALLEY
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State | WA
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Zip | 99206-4997
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Country | US
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Telephone | 509-921-7818
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Fax | 509-891-0456
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Provider Business Mailing Address
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Address Line | 11915 E BROADWAY AVE STE 100
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City | SPOKANE VALLEY
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State | WA
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Zip | 99206-4997
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Country | US
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Telephone | 509-921-7818
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Fax | 509-891-0456
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT00005793
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License Number State | WA
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