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Organization

COUNTRYSIDE THERAPY SERVICE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JOHN T O'DELL PT (OWNER)
(920) 564-6107
Entity
Organization

Contact information

Practice address
W4523 COUNTY ROAD IW, WALDO, WI 53093-1639
(920) 564-6107
Mailing address
PO BOX 1127, SHEBOYGAN, WI 53082-1127
(920) 457-6750
(920) 457-8350

Taxonomy

Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
5421-024
WI

Other

Enumeration date
10/13/2008
Last updated
10/13/2008
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