Provider Demographics
NPI:1164511010
Name:O'DONNELL, STEVEN (PT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
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 1:8600 QUAIL OAK WAY
Mailing Address - Street 2:
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-4430
Mailing Address - Country:US
Mailing Address - Phone:916-847-3548
Mailing Address - Fax:916-988-1106
Practice Address - Street 1:8600 QUAIL OAK WAY
Practice Address - Street 2:
Practice Address - City:ORANGEVALE
Practice Address - State:CA
Practice Address - Zip Code:95662-4430
Practice Address - Country:US
Practice Address - Phone:916-847-3548
Practice Address - Fax:916-988-1106
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27002225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT270023OtherMEDICARE ID