Healthcare Provider Details

I. General information

NPI: 1144985425
Provider Name (Legal Business Name): ZANE OBRIEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 E JAMESTOWN RD
GREENVILLE PA
16125-9206
US

IV. Provider business mailing address

290 N PERRY HWY
MERCER PA
16137-5038
US

V. Phone/Fax

Practice location:
  • Phone: 724-588-7610
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTEI006092
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: