Healthcare Provider Details

I. General information

NPI: 1093938565
Provider Name (Legal Business Name): JANET HERSCHEL OBRIEN P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANET FAIRLEE HERSCHEL P.T.

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5633 WESTWIND LN
SARASOTA FL
34231-8427
US

IV. Provider business mailing address

5633 WESTWIND LN
SARASOTA FL
34231-8427
US

V. Phone/Fax

Practice location:
  • Phone: 941-923-1118
  • Fax:
Mailing address:
  • Phone: 941-923-1118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number17542
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14335
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: