Provider Demographics
NPI:1497788335
Name:ODOM, SUSAN P (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:P
Last Name:ODOM
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 1:1800 WESTWIND DR
Mailing Address - Street 2:#107
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3055
Mailing Address - Country:US
Mailing Address - Phone:661-327-4685
Mailing Address - Fax:661-327-1959
Practice Address - Street 1:1800 WESTWIND DR
Practice Address - Street 2:#107
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3055
Practice Address - Country:US
Practice Address - Phone:661-327-4685
Practice Address - Fax:661-327-1959
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10170225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ19077ZMedicare ID - Type UnspecifiedSOUTHCOAST