Healthcare Provider Details

I. General information

NPI: 1013634526
Provider Name (Legal Business Name): NIALL O'BRIEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PATEWOOD DR STE C150
GREENVILLE SC
29615-6323
US

IV. Provider business mailing address

1610 ALLEN TOUSSAINT BLVD APT 105
NEW ORLEANS LA
70122-2853
US

V. Phone/Fax

Practice location:
  • Phone: 864-454-0904
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: