MEDICARE: O'BRIEN PHYSICAL THERAPY, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1063609477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	O'BRIEN PHYSICAL THERAPY, PLLC

Provider Business Mailing Address
First Line	:	6910 E CHAUNCEY LN
Second Line	:	STE 115
City	:	PHOENIX
State	:	AZ
Zip	:	85054-5160
Country	:	US
Telephone Number	:	602-538-6736
Fax Number	:

Provider Business Practice Location Address
First Line	:	6910 E CHAUNCEY LN
Second Line	:	STE 115
City	:	PHOENIX
State	:	AZ
Zip	:	85054-5160
Country	:	US
Telephone Number	:	602-538-6736
Fax Number	:

Authorized Official
Title or Position	:	OWNER-PHYSICAL THERAPIST
Name	:	DR. PATRICK JOHN O'BRIEN
Credential	:	PT, DPT
Telephone Number	:	602-538-6736

Provider Enumeration Date	:	09/29/2007
Last Update Date	:	12/07/2007

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