Provider Demographics
NPI:1154877843
Name:ODOM, RACHEL ELAINE (PT, DPT)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ELAINE
Last Name:ODOM
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:ELAINE
Other - Last Name:COLLVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9140 BELVOIR WOODS PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT BELVOIR
Mailing Address - State:VA
Mailing Address - Zip Code:22060-2703
Mailing Address - Country:US
Mailing Address - Phone:703-799-1200
Mailing Address - Fax:703-799-0189
Practice Address - Street 1:9140 BELVOIR WOODS PKWY
Practice Address - Street 2:
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-2703
Practice Address - Country:US
Practice Address - Phone:703-799-1200
Practice Address - Fax:703-799-0189
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305210575225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist