Provider Demographics
NPI:1083440507
Name:O'DELL, NOAH JAMES (PT, DPT)
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:JAMES
Last Name:O'DELL
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-6349
Mailing Address - Country:US
Mailing Address - Phone:914-302-2190
Mailing Address - Fax:
Practice Address - Street 1:48 ROUTE 6
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-6349
Practice Address - Country:US
Practice Address - Phone:914-302-2190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053093225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist