Provider Demographics
NPI:1538841309
Name:O'BRIEN, THEODORE JAMES
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:JAMES
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 2ND AVE RM 701
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-4500
Mailing Address - Country:US
Mailing Address - Phone:212-499-0848
Mailing Address - Fax:
Practice Address - Street 1:815 2ND AVE RM 701
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-4500
Practice Address - Country:US
Practice Address - Phone:212-499-0848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist