Provider Demographics
NPI:1700138088
Name:SEWELL, ODESSA Q (PT)
Entity Type:Individual
Prefix:
First Name:ODESSA
Middle Name:Q
Last Name:SEWELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ODESSA
Other - Middle Name:A
Other - Last Name:QUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11470 PINE HILL DR
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:PA
Mailing Address - Zip Code:17268-9357
Mailing Address - Country:US
Mailing Address - Phone:417-396-1184
Mailing Address - Fax:
Practice Address - Street 1:201 FRANKLIN FARM LN
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17202-3060
Practice Address - Country:US
Practice Address - Phone:717-264-2715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23938225100000X
PAPT021965225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist