Provider Demographics
NPI:1245282961
Name:O'DONNELL, CHRISTOPHER STEPHEN (PT)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:STEPHEN
Last Name:O'DONNELL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3037 W KELLER DR
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-1572
Mailing Address - Country:US
Mailing Address - Phone:623-512-6065
Mailing Address - Fax:480-907-2301
Practice Address - Street 1:3555 W PINNACLE PEAK RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310-4338
Practice Address - Country:US
Practice Address - Phone:623-512-6065
Practice Address - Fax:480-907-2301
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2701225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ101000Medicare ID - Type Unspecified