Basic Information
| Provider Information | |||||||||
| NPI: | 1003071291 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | O'DONNELL | ||||||||
| FirstName: | CLARISSA | ||||||||
| MiddleName: | THURMAN | ||||||||
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| Credential: | PT | ||||||||
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| OtherLastName: | THURMAN | ||||||||
| OtherFirstName: | CLARISSA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5300 DERRY ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171113576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178392110 | ||||||||
| FaxNumber: | 7175651934 | ||||||||
| Practice Location | |||||||||
| Address1: | 5108 E TRINDLE RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MECHANICSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170503300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177909920 | ||||||||
| FaxNumber: | 7177909923 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2008 | ||||||||
| LastUpdateDate: | 11/30/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT011676L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 2251P0200X | PT011676L | PA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics |
No ID Information.