Provider Demographics
NPI: | 1003071291 |
---|---|
Name: | O'DONNELL, CLARISSA THURMAN (PT) |
Entity Type: | Individual |
Prefix: | |
First Name: | CLARISSA |
Middle Name: | THURMAN |
Last Name: | O'DONNELL |
Suffix: | |
Gender: | F |
Credentials: | PT |
Other - Prefix: | |
Other - First Name: | CLARISSA |
Other - Middle Name: | |
Other - Last Name: | THURMAN |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | |
Mailing Address - Street 1: | 5300 DERRY ST |
Mailing Address - Street 2: | 2ND FLOOR |
Mailing Address - City: | HARRISBURG |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 17111-3576 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 717-839-2110 |
Mailing Address - Fax: | 717-565-1934 |
Practice Address - Street 1: | 5108 E TRINDLE RD |
Practice Address - Street 2: | SUITE 200 |
Practice Address - City: | MECHANICSBURG |
Practice Address - State: | PA |
Practice Address - Zip Code: | 17050-3300 |
Practice Address - Country: | US |
Practice Address - Phone: | 717-790-9920 |
Practice Address - Fax: | 717-790-9923 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2008-07-28 |
Last Update Date: | 2015-11-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | PT011676L | 225100000X, 2251P0200X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | |
No | 2251P0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics |