Healthcare Provider Details

I. General information

NPI: 1831460799
Provider Name (Legal Business Name): TERI L OBRIEN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2012
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 WASHINGTON ST
HOLLYWOOD FL
33021-7353
US

IV. Provider business mailing address

650 SE 12TH ST #203
DANIA FL
33004-5360
US

V. Phone/Fax

Practice location:
  • Phone: 954-981-6300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number20311
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: