Provider Demographics
NPI:1316467855
Name:O'DONNEL, ANDREW (PT/DPT)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:O'DONNEL
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:PO BOX 963
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49685-0963
Mailing Address - Country:US
Mailing Address - Phone:231-421-9277
Mailing Address - Fax:231-421-8447
Practice Address - Street 1:3899 W FRONT ST STE 3
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-8104
Practice Address - Country:US
Practice Address - Phone:231-421-9277
Practice Address - Fax:231-421-8447
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501018244225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist