Provider Demographics
NPI:1700899424
Name:RICHE, ODIA ELAINE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:ODIA
Middle Name:ELAINE
Last Name:RICHE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3581 LAGO DE TALAVERA
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33467-1072
Mailing Address - Country:US
Mailing Address - Phone:561-827-6157
Mailing Address - Fax:561-433-1600
Practice Address - Street 1:3581 LAGO DE TALAVERA
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33467-1072
Practice Address - Country:US
Practice Address - Phone:561-827-6157
Practice Address - Fax:561-433-1600
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20064225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL887322400Medicaid
FL887322400Medicaid