MEDICARE: MR. ANDREW O'DONNEL PT/DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5501018244	MI

General Provider Information

NPI Number	:	1316467855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANDREW O'DONNEL PT/DPT

Provider Business Mailing Address
First Line	:	PO BOX 963
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49685-0963
Country	:	US
Telephone Number	:	231-421-9277
Fax Number	:	231-421-8447

Provider Business Practice Location Address
First Line	:	3899 W FRONT ST STE 3
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-8104
Country	:	US
Telephone Number	:	231-421-9277
Fax Number	:	231-421-8447

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2017
Last Update Date	:	06/26/2017

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