Provider Demographics
NPI:1568267706
Name:OBODO, ISAAC
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:
Last Name:OBODO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3864 VILLAFLORA DR APT 5307
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-7146
Mailing Address - Country:US
Mailing Address - Phone:925-895-6840
Mailing Address - Fax:
Practice Address - Street 1:3864 VILLAFLORA DR APT 5307
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-7146
Practice Address - Country:US
Practice Address - Phone:925-895-6840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer