Provider Demographics
NPI:1124305966
Name:O'DONNELL PHYSICAL THERAPY CORP.
Entity type:Organization
Organization Name:O'DONNELL PHYSICAL THERAPY CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'DONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:916-847-3548
Mailing Address - Street 1:108 VAN WINKLE CT
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-1962
Mailing Address - Country:US
Mailing Address - Phone:916-847-3548
Mailing Address - Fax:916-988-1106
Practice Address - Street 1:108 VAN WINKLE CT
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-1962
Practice Address - Country:US
Practice Address - Phone:916-847-3548
Practice Address - Fax:916-988-1106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27002261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT270023OtherMEDICARE ID
1164511010OtherNPI