Provider Demographics
NPI:1154470367
Name:O'DEA, SEAN PATRICK
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:PATRICK
Last Name:O'DEA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 LAKEHURST RD
Mailing Address - Street 2:STE 202&204
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-8063
Mailing Address - Country:US
Mailing Address - Phone:732-349-1201
Mailing Address - Fax:973-887-3816
Practice Address - Street 1:4253 US HIGHWAY 9
Practice Address - Street 2:BLDG 4 UNIT A
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-8309
Practice Address - Country:US
Practice Address - Phone:732-780-9033
Practice Address - Fax:732-780-8680
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA07005900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ085418MOZMedicare ID - Type Unspecified