MEDICARE: DR. PATRICK JOHN O'BRIEN P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5864	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ0462730	OTHER	AZ	BCBS AZ #

General Provider Information

NPI Number	:	1104915289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK JOHN O'BRIEN P.T.

Provider Business Mailing Address
First Line	:	16421 N TATUM BLVD
Second Line	:	STE. 201
City	:	PHOENIX
State	:	AZ
Zip	:	85032-3454
Country	:	US
Telephone Number	:	602-485-8000
Fax Number	:	602-485-8010

Provider Business Practice Location Address
First Line	:	16421 N TATUM BLVD
Second Line	:	STE. 201
City	:	PHOENIX
State	:	AZ
Zip	:	85032-3454
Country	:	US
Telephone Number	:	602-485-8000
Fax Number	:	602-485-8010

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/09/2007

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Directions to “ DR. PATRICK JOHN O'BRIEN P.T.” Practice Location

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