Individual provider Active NPI

Patricia Odom

  • Orthopedic Physical Therapist
  • MC Lean, VA
National Provider Identifier
1972911931
Registry record updated Jul 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
2305202952 Issued in VA
Practice address
6849 Old Dominion Dr
Suite 330
MC Lean, VA 22101-3724
Phone
(703) 848-9333
NPI assigned
Jul 23, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 23, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical Therapist 2251X0800X 2305202952 VA Primary

Addresses

Primary practice location

6849 Old Dominion Dr
Suite 330
MC Lean, VA 22101-3724

Mailing address

6231 Lakeview Dr
Falls Church, VA 22041-1335

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141201000319 DC Practitioner - Physical Therapist in Private Practice 4486976503 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1998
Medicare assignment
May accept Medicare assignment
Group practices
Pro Motion Physical Therapy, LLCGroup PAC ID 3971402348, 7 clinicians

Practice addresses (Care Compare)

6849 Old Dominion Dr
Suite 330
MC Lean, VA 22101-3791
Phone (703) 848-9333

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2305202952VAMDOrthopedic Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Pro Motion Physical Therapy, LLC CurrentSince Jul 16, 2014 Accepting new patients

Locations

6849 Old Dominion Dr
Ste 330
McLean, VA 22101
Phone (703) 848-9333

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1406073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406073600000",
    "number": "1972911931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6231 LAKEVIEW DR",
            "city": "FALLS CHURCH",
            "state": "VA",
            "postal_code": "220411335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6849 OLD DOMINION DR",
            "address_2": "SUITE 330",
            "city": "MC LEAN",
            "state": "VA",
            "postal_code": "221013724",
            "telephone_number": "703-848-9333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODOM",
        "first_name": "PATRICIA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-07-23",
        "last_updated": "2014-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "VA",
            "license": "2305202952",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in MC Lean, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.