Provider Demographics
NPI:1912543638
Name:AQRABAWI, ODAI MICHAEL
Entity Type:Individual
Prefix:
First Name:ODAI
Middle Name:MICHAEL
Last Name:AQRABAWI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 FARRINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-4259
Mailing Address - Country:US
Mailing Address - Phone:214-536-4151
Mailing Address - Fax:
Practice Address - Street 1:2920 N STEMMONS FWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-6103
Practice Address - Country:US
Practice Address - Phone:214-630-2331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1325902225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist