Lisa K Odabachian, MPT, RN, BSN

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501010921 Issued in MI

Practice address

43902 Woodward Ave Ste 120
Bloomfield Hills, MI 48302-5021

Phone

(248) 338-8323

Fax

(248) 338-7600

NPI assigned

Aug 15, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Bachelor on Science - Nursing, Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692230400000",
    "number": "1669485090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43902 WOODWARD AVE STE 120",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483025021",
            "telephone_number": "248-338-7600",
            "fax_number": "248-338-8323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43902 WOODWARD AVE STE 120",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483025021",
            "telephone_number": "248-338-8323",
            "fax_number": "248-338-7600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODABACHIAN",
        "first_name": "LISA",
        "middle_name": "K",
        "name_prefix": "Ms.",
        "credential": "MPT, RN, BSN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-15",
        "last_updated": "2023-08-17",
        "certification_date": "2023-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501010921",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Bloomfield Hills, MI
• Providers in Bloomfield Hills, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.