Provider Demographics
NPI:1982823860
Name:O'DONNELL, SALLY ANNE (LPTA)
Entity Type:Individual
Prefix:MISS
First Name:SALLY
Middle Name:ANNE
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17996 BRUSHY FORK RD SE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43056-9435
Mailing Address - Country:US
Mailing Address - Phone:740-763-0520
Mailing Address - Fax:330-897-0515
Practice Address - Street 1:130 BUENA VISTA ST
Practice Address - Street 2:
Practice Address - City:BALTIC
Practice Address - State:OH
Practice Address - Zip Code:43804-9669
Practice Address - Country:US
Practice Address - Phone:330-897-4311
Practice Address - Fax:330-897-0515
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1200225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant