Provider Demographics
NPI:1245988120
Name:ODULIO, ALDOUS PETER JOSHUA BARORO (PT)
Entity type:Individual
Prefix:
First Name:ALDOUS PETER JOSHUA
Middle Name:BARORO
Last Name:ODULIO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3682 CHIPPENDALE CIR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-5355
Mailing Address - Country:US
Mailing Address - Phone:347-410-0253
Mailing Address - Fax:
Practice Address - Street 1:12185 CLIPPER DR
Practice Address - Street 2:
Practice Address - City:LAKE RIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2236
Practice Address - Country:US
Practice Address - Phone:703-496-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT010839225100000X
VA2305214744225100000X
NY039677225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist