Provider Demographics
NPI:1083952725
Name:ODEN, AMY ELIZABETH (PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:ODEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:ELIZABETH
Other - Last Name:HORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2600 ELDORADO PKWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-4367
Mailing Address - Country:US
Mailing Address - Phone:972-984-7672
Mailing Address - Fax:972-984-7671
Practice Address - Street 1:2600 ELDORADO PKWY
Practice Address - Street 2:SUITE 130
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-4367
Practice Address - Country:US
Practice Address - Phone:972-984-7672
Practice Address - Fax:972-984-7671
Is Sole Proprietor?:No
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1126518225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist