Provider Demographics
NPI:1538168992
Name:ODONOHUE, JAMES M SR (PT, OCS, ATC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:M
Last Name:ODONOHUE
Suffix:SR
Gender:M
Credentials:PT, OCS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N RICHMOND ST
Mailing Address - Street 2:
Mailing Address - City:FLEETWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19522-1308
Mailing Address - Country:US
Mailing Address - Phone:610-944-6945
Mailing Address - Fax:
Practice Address - Street 1:31 INDUSTRIAL DR
Practice Address - Street 2:SUITE 129
Practice Address - City:HAMBURG
Practice Address - State:PA
Practice Address - Zip Code:19526-8778
Practice Address - Country:US
Practice Address - Phone:610-562-1700
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005820L2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA07613139Medicaid
PA11228616OtherCAQH
PA11228616OtherCAQH