Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 60475169 | WA |
N | 2251S0007X | Physical Therapist - Sports | 4716 | OR |
N | 2251X0800X | Physical Therapist - Orthopedic | 4716 | OR |
NPI | 1134362486 |
---|---|
Provider Name | Thomas John O'donnell |
First Address | Walla Walla, WA 99362-2846 |
Second Address | Walla Walla, WA 99362-2846 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2009 |
Last Update Date | 08/12/2016 |