Healthcare Provider Details

I. General information

NPI: 1891197430
Provider Name (Legal Business Name): AMY O'BRIEN MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY CORAZZARI MPT

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16985 W BLUEMOUND RD
BROOKFIELD WI
53005-5909
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 262-821-4460
  • Fax:
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number10023-024
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10023-024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: