Provider Demographics
NPI:1093219875
Name:O'DRISCOLL, PATRICIA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:O'DRISCOLL
Suffix:
Gender:F
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 1:3936 W BANFF LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-4519
Mailing Address - Country:US
Mailing Address - Phone:602-475-1564
Mailing Address - Fax:
Practice Address - Street 1:19420 N 59TH AVE STE E500
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-6881
Practice Address - Country:US
Practice Address - Phone:623-208-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13690225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist