Healthcare Provider Details

I. General information

NPI: 1285847202
Provider Name (Legal Business Name): RICHARD FERRIS OBRIEN III A.T.,C, M.ED., P.T.A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 S 40TH AVE
YAKIMA WA
98908-3961
US

IV. Provider business mailing address

707 N. 12TH STREET
SELAH WA
98942
US

V. Phone/Fax

Practice location:
  • Phone: 509-966-8981
  • Fax: 509-966-2125
Mailing address:
  • Phone: 509-966-8981
  • Fax: 509-966-2125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: