Provider Demographics
NPI:1972863892
Name:ODEVILAS, ROSENDO ODRONIA (PT)
Entity Type:Individual
Prefix:MR
First Name:ROSENDO
Middle Name:ODRONIA
Last Name:ODEVILAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3326 BOYD CIR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:FL
Mailing Address - Zip Code:34484-3589
Mailing Address - Country:US
Mailing Address - Phone:954-804-6574
Mailing Address - Fax:
Practice Address - Street 1:1460 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-0040
Practice Address - Country:US
Practice Address - Phone:352-750-0866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT27362225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist