Provider Demographics
NPI:1700932878
Name:ODDERS, ROSEMARY JO-MEI (DPT)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:JO-MEI
Last Name:ODDERS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3213 W CHARLESTON BLVD
Mailing Address - Street 2:STE 105
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1991
Mailing Address - Country:US
Mailing Address - Phone:702-235-6017
Mailing Address - Fax:
Practice Address - Street 1:3213 W CHARLESTON BLVD
Practice Address - Street 2:STE 105
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1991
Practice Address - Country:US
Practice Address - Phone:702-570-6222
Practice Address - Fax:702-570-6234
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2412225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1700932878Medicaid