Basic Information
| Provider Information | |||||||||
| NPI: | 1154470367 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | O'DEA | ||||||||
| FirstName: | SEAN | ||||||||
| MiddleName: | PATRICK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 530 LAKEHURST RD | ||||||||
| Address2: | STE 202&204 | ||||||||
| City: | TOMS RIVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087558063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323491201 | ||||||||
| FaxNumber: | 9738873816 | ||||||||
| Practice Location | |||||||||
| Address1: | 4253 US HIGHWAY 9 | ||||||||
| Address2: | BLDG 4 UNIT A | ||||||||
| City: | FREEHOLD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077288309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327809033 | ||||||||
| FaxNumber: | 7327808680 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2007 | ||||||||
| LastUpdateDate: | 02/14/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA07005900 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.