Provider Demographics
NPI:1528102639
Name:O'GRADY, SEAN PATRICK (PTA)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:PATRICK
Last Name:O'GRADY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CAVANAUGH RD
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-1713
Mailing Address - Country:US
Mailing Address - Phone:781-817-5260
Mailing Address - Fax:
Practice Address - Street 1:4 CAVANAUGH RD
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-1713
Practice Address - Country:US
Practice Address - Phone:781-817-5260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3533225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant