Provider Demographics
NPI:1275798027
Name:ODIA, SUSANA (PT)
Entity Type:Individual
Prefix:
First Name:SUSANA
Middle Name:
Last Name:ODIA
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 1:2415 HOLLYWOOD BLVD
Mailing Address - Street 2:APT.# 302
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-6605
Mailing Address - Country:US
Mailing Address - Phone:954-456-0250
Mailing Address - Fax:954-456-0820
Practice Address - Street 1:1075 93RD ST
Practice Address - Street 2:APT. # 302
Practice Address - City:BAY HARBOR ISLANDS
Practice Address - State:FL
Practice Address - Zip Code:33154-2389
Practice Address - Country:US
Practice Address - Phone:305-866-2629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23923251E00000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No251E00000XAgenciesHome Health