Provider Demographics
NPI:1457860322
Name:MORALES, ODESSA (PHYSICAL THERAPY)
Entity Type:Individual
Prefix:MRS
First Name:ODESSA
Middle Name:
Last Name:MORALES
Suffix:
Gender:F
Credentials:PHYSICAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 S CANFIELD NILES RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-4024
Mailing Address - Country:US
Mailing Address - Phone:330-799-4446
Mailing Address - Fax:330-799-3860
Practice Address - Street 1:550 S CANFIELD NILES RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-4024
Practice Address - Country:US
Practice Address - Phone:330-799-4446
Practice Address - Fax:330-799-3860
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-23
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040974225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist