Provider Demographics
NPI:1780667311
Name:ODELL, LEIGH A (PT)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:A
Last Name:ODELL
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 1:3910 TEAYS VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9756
Mailing Address - Country:US
Mailing Address - Phone:304-757-7293
Mailing Address - Fax:304-757-0574
Practice Address - Street 1:3910 TEAYS VALLEY RD
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9756
Practice Address - Country:US
Practice Address - Phone:304-757-7293
Practice Address - Fax:304-757-0574
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002378225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9301591Medicare PIN
WV1037690001Medicare NSC
WV9301592Medicare PIN