Provider Demographics
NPI:1144328782
Name:O'DONNELL, DANIEL RICHARD (PT)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:RICHARD
Last Name:O'DONNELL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 PENNWOOD CIR S
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-1748
Mailing Address - Country:US
Mailing Address - Phone:727-585-4734
Mailing Address - Fax:727-442-2646
Practice Address - Street 1:1236 DRUID RD E
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-4210
Practice Address - Country:US
Practice Address - Phone:727-442-2236
Practice Address - Fax:727-442-2646
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 3491225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY2522ZMedicare ID - Type Unspecified
FLK8249Medicare ID - Type UnspecifiedGROUP ID