Active NPI
Sandra Delorise Odens, PHYSICALTHERAPISTASS
- Physical Therapist
- Bedford, OH
National Provider Identifier
1174553002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 050
- Practice address
- 5555 Vickie LN
Bedford, OH 44146-2457 - Phone
- (440) 232-2661
- NPI assigned
- Jul 4, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 050 | OH | Primary |
Addresses
Primary practice location
5555 Vickie LN
Bedford, OH 44146-2457
Mailing address
5555 Vickie LN
Bedford, OH 44146-2457
Phone (440) 232-2661
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 050 | Other | OH | LICENCE# |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 050 | OH | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151971200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1174553002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5555 VICKIE LN",
"city": "BEDFORD",
"state": "OH",
"postal_code": "441462457",
"telephone_number": "440-232-2661"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5555 VICKIE LN",
"city": "BEDFORD",
"state": "OH",
"postal_code": "441462457",
"telephone_number": "440-232-2661"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODENS",
"first_name": "SANDRA",
"middle_name": "DELORISE",
"name_prefix": "Mrs.",
"credential": "PHYSICALTHERAPISTASS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OH",
"license": "050",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENCE#",
"identifier": "050",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bedford, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.