Healthcare Provider Details

I. General information

NPI: 1750547675
Provider Name (Legal Business Name): RICHARD JAMES OBRIEN MPSPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 08/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7325 OSWEGO RD
LIVERPOOL NY
13090-3717
US

IV. Provider business mailing address

7325 OSWEGO RD
LIVERPOOL NY
13090-3717
US

V. Phone/Fax

Practice location:
  • Phone: 315-451-6541
  • Fax: 315-451-7059
Mailing address:
  • Phone: 315-451-6541
  • Fax: 315-451-7059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number022181
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: