NPIMap

Individual provider Active NPI

John Tyus O'Dell, P.T.

  • Physical Therapist
  • Oostburg, WI
National Provider Identifier
1124105945
Registry record updated Aug 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5421-024 Issued in WI
Practice address
110 N 9TH St
Oostburg, WI 53070-1174
Phone
(920) 564-3699
Fax
(920) 564-3605
NPI assigned
Nov 1, 2006
Last updated
Aug 5, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 5421-024 WI Primary

Addresses

Primary practice location

110 N 9TH St
Oostburg, WI 53070-1174

Mailing address

W4523 County Road Iw
Waldo, WI 53093-1639
Phone (920) 564-6107

Other identifiers 2

IdentifierTypeStateIssuer
40314400MedicaidWI
0007431405OtherWIAETNA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5421-024WIMDPhysical Therapist
5421WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Great Lakes Physical Therapy, LLC Physical Therapist Past Accepting new patients
Easy Living Home Health Care Agency, Inc. Physical Therapist Past Accepting new patients
Hands-Plus Therapy Services LLC Past Accepting new patients

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1217894400000",
    "number": "1124105945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W4523 COUNTY ROAD IW",
            "city": "WALDO",
            "state": "WI",
            "postal_code": "530931639",
            "telephone_number": "920-564-6107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 N 9TH ST",
            "city": "OOSTBURG",
            "state": "WI",
            "postal_code": "530701174",
            "telephone_number": "920-564-3699",
            "fax_number": "920-564-3605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'DELL",
        "first_name": "JOHN",
        "middle_name": "TYUS",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2008-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "5421-024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40314400",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0007431405",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oostburg, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.