Provider Demographics
NPI:1225203037
Name:ODONNELL, KRISTY ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:ANN
Last Name:ODONNELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7706 W BRANDON CT
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:IL
Mailing Address - Zip Code:61547-9687
Mailing Address - Country:US
Mailing Address - Phone:309-697-9407
Mailing Address - Fax:
Practice Address - Street 1:6501 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-2932
Practice Address - Country:US
Practice Address - Phone:309-692-8110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist