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Organization
ODOM SPORTS MEDICINE, P.A.
Active
Organization
ODOM SPORTS MEDICINE, P.A.
Active
Parent organization
ODOM SPORTS MEDICINE, P.A.
Other names
Odom Health and Wellness
Organization subpart
Yes
Provider details
NPI number
Legal business name
ODOM SPORTS MEDICINE, P.A.
Authorized official
DR. JOHN H.L. ODOM JR. M.D. (PRESIDENT)
(952) 224-1919
Entity
Organization
Contact information
Practice address
500 S CHERRY ST, WACONIA, MN 55387-4515
(952) 856-4722
Mailing address
10500 WAYZATA BLVD, MINNETONKA, MN 55305-1511
(952) 224-1919
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
—
NULL
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
—
—
225100000X
Physical Therapist
—
NULL
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
NULL
225X00000X
Occupational Therapist
—
—
Other
Enumeration date
05/02/2013
Last updated
05/02/2013
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