Provider Demographics
NPI:1003071291
Name:O'DONNELL, CLARISSA THURMAN (PT)
Entity type:Individual
Prefix:
First Name:CLARISSA
Middle Name:THURMAN
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CLARISSA
Other - Middle Name:
Other - Last Name:THURMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5300 DERRY ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-3576
Mailing Address - Country:US
Mailing Address - Phone:717-839-2110
Mailing Address - Fax:717-565-1934
Practice Address - Street 1:5108 E TRINDLE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-3300
Practice Address - Country:US
Practice Address - Phone:717-790-9920
Practice Address - Fax:717-790-9923
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011676L225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics