Provider Demographics
NPI:1104915289
Name:O'BRIEN, PATRICK JOHN (PT)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JOHN
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16421 N TATUM BLVD
Mailing Address - Street 2:STE. 201
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-3454
Mailing Address - Country:US
Mailing Address - Phone:602-485-8000
Mailing Address - Fax:602-485-8010
Practice Address - Street 1:16421 N TATUM BLVD
Practice Address - Street 2:STE. 201
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3454
Practice Address - Country:US
Practice Address - Phone:602-485-8000
Practice Address - Fax:602-485-8010
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5864225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0462730OtherBCBS AZ #
AZAZ0462730OtherBCBS AZ #