Provider Demographics
NPI:1063657781
Name:O'DELL, BETTY GAY (PT)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:GAY
Last Name:O'DELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N BEDELL AVE
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-4111
Mailing Address - Country:US
Mailing Address - Phone:830-775-9118
Mailing Address - Fax:830-775-9229
Practice Address - Street 1:710 N BEDELL AVE
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-4111
Practice Address - Country:US
Practice Address - Phone:830-775-9118
Practice Address - Fax:830-775-9229
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1011740225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist