Individual
JOHN TYUS O'DELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
110 N 9TH ST, OOSTBURG, WI 53070-1174
(920) 564-3699
(920) 564-3605
Mailing address
W4523 COUNTY ROAD IW, WALDO, WI 53093-1639
(920) 564-6107
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5421-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007431405
AETNA
WI
05
—
40314400
—
WI
Enumeration date
11/01/2006
Last updated
08/05/2008
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