Basic Information
| Provider Information | |||||||||
| NPI: | 1972911931 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ODOM | ||||||||
| FirstName: | PATRICIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6231 LAKEVIEW DR | ||||||||
| Address2: | |||||||||
| City: | FALLS CHURCH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220411335 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 6849 OLD DOMINION DR | ||||||||
| Address2: | SUITE 330 | ||||||||
| City: | MC LEAN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221013724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038489333 | ||||||||
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| ProviderEnumerationDate: | 07/23/2014 | ||||||||
| LastUpdateDate: | 07/23/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | 2305202952 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.