MEDICARE: STEPHEN RACHEL O'BRIEN PT, DPT

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	5501013090	MI

General Provider Information

NPI Number	:	1346657863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN RACHEL O'BRIEN PT, DPT

Provider Business Mailing Address
First Line	:	6206 EMERALD DR
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-7809
Country	:	US
Telephone Number	:	810-406-9466
Fax Number	:	810-603-2509

Provider Business Practice Location Address
First Line	:	4250 N SAGINAW ST STE C
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48505-5332
Country	:	US
Telephone Number	:	810-406-9466
Fax Number	:

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

Provider Enumeration Date	:	07/16/2014
Last Update Date	:	02/26/2020

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