Provider Demographics
NPI:1457665887
Name:O'DELL, ROBERT J (PT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:O'DELL
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 1:8304 ALOPHIA DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739-1999
Mailing Address - Country:US
Mailing Address - Phone:512-699-2162
Mailing Address - Fax:512-572-3272
Practice Address - Street 1:4425 S MOPAC EXPY STE 101
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-6710
Practice Address - Country:US
Practice Address - Phone:512-669-2162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1121366225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist