Provider Demographics
NPI:1962681106
Name:ODLE, JEANNE SNOWDEN (PT)
Entity Type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:SNOWDEN
Last Name:ODLE
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 1:1108 W KILPATRICK ST
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-7477
Mailing Address - Country:US
Mailing Address - Phone:817-202-9520
Mailing Address - Fax:817-202-0017
Practice Address - Street 1:1108 W KILPATRICK ST
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-7477
Practice Address - Country:US
Practice Address - Phone:817-202-9520
Practice Address - Fax:817-202-0017
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1032597225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist