Provider Demographics
NPI:1669501920
Name:ODEN, CYNTHIA A (MSPT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:ODEN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:A
Other - Last Name:ODEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSPT
Mailing Address - Street 1:6926 LAFAYETTE PARK DR
Mailing Address - Street 2:ANNANDALE
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3225
Mailing Address - Country:US
Mailing Address - Phone:703-732-8998
Mailing Address - Fax:
Practice Address - Street 1:5255 LOUGHBORO RD NW
Practice Address - Street 2:WASHINGTON
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2633
Practice Address - Country:US
Practice Address - Phone:202-364-7665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3330225100000X
VA2305205861225100000X
DCPT871672225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist