Provider Demographics
NPI:1710220165
Name:O'DRISCOLL, SUE DANIELS (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:DANIELS
Last Name:O'DRISCOLL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:DANIELS
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:555 AMORY ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2652
Mailing Address - Country:US
Mailing Address - Phone:617-383-6522
Mailing Address - Fax:617-383-6520
Practice Address - Street 1:12448 SW 127TH AVE FL 2
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6596
Practice Address - Country:US
Practice Address - Phone:704-737-3182
Practice Address - Fax:617-383-6520
Is Sole Proprietor?:No
Enumeration Date:2013-04-04
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
FLPT38030225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist