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General NPI Number Information
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NPI Number | 1972911931
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Entity Type | Individual
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Provider Name | PATRICIA ODOM
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Gender | Female
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Dates
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Enumeration Date | 07/23/2014
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Last Update Date | 07/23/2014
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Provider Practice Location Address
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Address Line | 6849 OLD DOMINION DR SUITE 330
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City | MC LEAN
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State | VA
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Zip | 22101-3724
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Country | US
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Telephone | 703-848-9333
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Fax |
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Provider Business Mailing Address
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Address Line | 6231 LAKEVIEW DR
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City | FALLS CHURCH
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State | VA
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Zip | 22041-1335
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 2305202952
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License Number State | VA
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