Provider Demographics
NPI:1669455275
Name:O'DONNELL, JUDY NUTTALL (PT)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:NUTTALL
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:JUDY
Other - Middle Name:LYNN
Other - Last Name:O'DONNELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:CMR 402 BOX 927
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09180-0927
Mailing Address - Country:US
Mailing Address - Phone:314-493-4086
Mailing Address - Fax:314-493-4236
Practice Address - Street 1:LRMC, CMR 402, BOX 927
Practice Address - Street 2:
Practice Address - City:LANDSTUHL
Practice Address - State:GERMANY
Practice Address - Zip Code:66789
Practice Address - Country:DE
Practice Address - Phone:314-493-4086
Practice Address - Fax:314-493-4236
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1026458225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist