Provider Demographics
NPI:1669485090
Name:ODABACHIAN, LISA K (MPT, RN, BSN)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:K
Last Name:ODABACHIAN
Suffix:
Gender:F
Credentials:MPT, RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43902 WOODWARD AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5021
Mailing Address - Country:US
Mailing Address - Phone:248-338-7600
Mailing Address - Fax:248-338-8323
Practice Address - Street 1:43902 WOODWARD AVE STE 120
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5021
Practice Address - Country:US
Practice Address - Phone:248-338-8323
Practice Address - Fax:248-338-7600
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010921225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist